antibiotic adjuncts to perio treatment

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  • 1.ANTIBIOTIC ADJUNCTSTO PERIO DONTAL TREATMENT Aneesha abdu Final year bds GUIDED BY DR BINIRAJ K R PROF&HOD PERIODONTICS

2.

  • Bacterial specificity
  • Should not produce resistant strains
  • Does not cause allergy or toxicity
  • Does not cause other side effects
  • Does not eliminate normal oral flora
  • Cost effective
  • Hence the ideal has not been found!

Properties of an Ideal Antibiotic 3. PERIODONTITIS

  • IS A COMPLEX DISEASE THAT INVOLVES THE LOSS OF ATTACHMENT AROUND TEETH RESULTING FROM ACTIONS OF MICROORGANISMS AND THE RESPONSE OF THE HOST TO THESE ORGANISMS.

4. PERIODONTITIS

  • THE MOST EFFECTIVE TREATMENT CURRENTLY REQUIRES MECHANICAL ROOT PREPARATION IN THE PRESENCE OR ABSENCEOF SURGICAL REVISION OF THE PERIODONTIUM.

5. PERIODONTITIS

  • TREATMENT CAN BE TIME CONSUMING, EXPENSIVE AND FRIGHTENING TO PATIENTS .

6. PERIODONTITIS

  • THE SEARCH FOR A MAGIC BULLET IS A HIGH PRIORITY

7. PERIODONTAL PATHOGENS

  • GRAM-NEGATIVE ANAEROBIC RODS
  • GRAM-POSITIVE FACULTATIVE AND ANAEROBIC COCCI AND RODS
  • GRAM-NEGATIVE FACULTATIVE RODS

8. PERIODONTITIS

  • A.a.
  • P. gingivalis
  • T. denticola
  • B. forsythus
  • P. intermedia
  • E. nodatum
  • Spirochetes

9. PERIODONTAL PATHOGENESIS DEPEND ON

  • TOTAL BACTERIAL LOAD
  • BINDING OF THE DRUG TO TISSUES
  • BIOINACTIVATION OF THE DRUG BY NONTARGET ORGANISMS
  • BIOFILM PRESENCEAFFORDING THE PATHOGEN PROTECTION
  • DRUG RESISTANT PATHOGENS
  • IMPAIRED HOST RESISTANCE
  • RECOLONIZATION FROM SUPRAGINGIVAL SITES AFTER TERMINATION OF ANTIMICROBIAL THERAPY

10. ANTIBIOTICS

  • PENICILLIN
  • MACROLIDES
  • TETRACYCLINE
  • CLINDAMYCIN
  • CIPROFLOXACIN
  • METRONIDAZOLE

11. SPECTRUM MACROLIDE CLINDA CEPHA AMPI/ AMOXY PEN G/ PEN VORODENTAL INFECTIONS 12. 13. Antibiotic Adjunctive Therapies

  • Treatment of aggressive periodontal diseases, chronic periodontitis, refractory periodontitis
    • Initial identification of pathogens
    • Appropriate antibiotic selection
    • Debridement should be carried out first
  • Systemic antibiotics commonly prescribed:
    • tetracyclines, metronidazole
    • amoxicillin, Augmentin, ampicillin
    • ciprofloxacin, clindamycin
    • Periostat ( doxycycline )

14. PENICILLINS

  • INHIBIT BACTERIAL WALL SYNTHESIS
  • INDICATED IN ACUTE INFECTIONS FROM GRAM-POSITIVE BACTERIA
  • RESISTANT ORGANISMS
  • AMOXICILLIN MORE EFFECTIVE
  • CAN BE COMBINED WITH CLAVULINIC ACID WHICH PROTECTS AMOXICILLINFROM DEGRADATION
  • NOT EFFECTIVE AGAINST Aa

15. MACROGLIDES

  • CLINICALLY ADMINISTRATION DECREASED PLAQUE BUT PATIENTS DEVELOPED ABSCESSES DURING THE STUDY WHICH WORSENED THE CLINICAL PARAMETERS
  • NO SIGNIFICANT OR LASTING EFFECT WAS SEEN

16. MACROGLIDES

  • ERYTHROMYCIN
  • CONTAINS A LACTONE RING TO WHICH SUGARS ARE ATTACHED WHICH BIND TO BACTERIAL RIBOSOMES AND DISRUPT PROTEIN SYNTHESIS
  • BACTERIOSTATIC
  • LIMITED ACTIVITY AGAINST PERIODONTAL PATHOGENS
  • LIMITED USE IN PERIODONTAL TREATMENT

17. TETRACYCLINES

  • MOST COMMONLY PRESCRIBED ANTIMICROBIALS IN PERIODONTICS
  • INHIBIT PROTEIN SYNTHESIS BY BINDING TO BACTERIAL RIBOSOMAL UNITS
  • BROAD SPECTRUM
  • INCLUDES TETRACYCLINE, DOXYCYCLINE,AND MINOCYCLINE
  • MORE EFFECTIVE AGAINST GRAM POSITIVE
  • GOOD ACTIVITY AGAINST SPIROCHETES, ANAEROBIC AND FACULTATIVE BACTERIA
  • HIGH CONCENTRATIONS IN CREVICULAR FLUID

18. TETRACYCLINES

  • CLINICAL USE IN ADULT PERIODONTITIS FOUND TETRACYCLINE TO BE NO DIFFERENT THAN PLACEBO
  • RELATIVE TO CHANGES IN PROBING DEPTHS, ATTACHMENT LEVELS AND PERCENTAGE OF SPIROCHETES.
  • HAVE BEEN WIDELY USED IN TREATMENT OF BOTH GENERALIZED AND LOCALIZED JUVENILE PERIODONTITIS
  • RELATIONSHIPS WERE FOUND BETWEEN THE DECREASE OF Aa IN THE POCKET AND AN INCREASE IN PROBING ATTACHMENT LEVELS.

19. TETRACYCLINES

  • CLINICAL USE IN REFRACTORY PERIODONTITIS WAS BENEFICIAL BY SIGNIFICANTLY REDUCING SPIROCHETES, MOTILE RODS,PROBING DEPTHS AND SUPPURATION.

20. Tetracycline Side Effects

  • Intrinsic tooth staining
  • GI upset, abdominal pain
  • Diarrhea, vomiting
  • Fungal overgrowth
  • Resistant bacterial strains
  • Interferes with bactericidal activity of penicillin's & cephalosporins

21. DOXYCYCLINE

  • A SIMILAR EFFICACY AND SPECTRUM OF ACTIVITY AS TETRACYCLINE
  • ELEVATED IN GINGIVAL CREVICULAR FLUID AT LEVELS COMPARABLETO TETRACYCLINE
  • ABSORPTION OF DOXYCYCLINE IS LESS SENSITIVE TO THE PRESENCE OF FOOD

22. CLINDAMYCIN

  • EFFECTIVE AGAINST GRAM-POSTITIVE AND MOST ANAEROBIC BACTERIA
  • INHIBITS BACTERIAL PROTEIN SYNTHESIS BY BINDING TO BACTERIAL RIBOSOMES
  • USE OF CLINDAMYCIN IN THE TREATMENT OF PERIODONTAL DISEASE HAS BEEN LIMITED BECAUSE OF POTENTIALLY SEVERE SIDE EFFECTS, SUCH AS ABDOMINAL DISCOMFORT, DIARRHEA, AND PSEUDOMEMBRANOUS COLITIS

23. CIPROFLOXACIN

  • A BROAD-SPECTRUM ANTIMICROBIAL THAT INHIBITS BACTERIAL DNA SYNTHESIS THROUGH ITS BINDING TO DNA GYRASE, AN ENZYME RESPONSIBLE FOR THE UNWINDING AND SUPERCOILING OF DNA.
  • EFFECTIVE AGAINST GRAM-NEGATIVE BACTERIA, STAPHYLOCOCCI, AND PSEUDOMONAS AERUGINOSA.
  • MAY PROMOTE THE REPOPULATION OF THE PERIODONTIUM WITH BENEFICIAL MICROFLORA BY VIRTUE OF ITS SELECTIVITY.

24. CIPROFLOXACIN

  • IT HAS A MINIMAL EFFECT ON STREPTOCOCCAL MICROBES
  • CIPROFLOXACIN THERAPY MAY FACILITATE THE REPOPULATION OF THE POCKET WITH MICROFLORA MORE ASSOCIATED WITH PERIODONTAL HEALTH

25. METRONIDAZOLE

  • A BROAD- SPECTRUM ANTIMICROBIAL, DISPLAYING ACTIVITY AGAINST ANAEROBIC COCCI, GRAM-NEATIVE BACILLI, AND GRAM-POSITIVE BACILLI
  • PERMEABLE THROUGH THE BACTERIAL CELL WALL, THE DRUG BINDS DNA AND DISRUPTS THE HELICAL STRUCTURE. BREAKAGE OF THE DNA STRANDS FOLLOWS LEADING TO CELL DEATH.
  • LEVELS OF THE DRUG IN CREVICULAR FLUID CAN APPROACH TWICE THAT IN THE SERUM.

26. METRONIDAZOLE

  • THE EFFECT OF THE METRONIDAZOLE WAS MAINTAINED FOR A TWO TO THREE YEAR RE-CALL PERIOD.IT CAN SIGNIFICANTLY REDUCE THE NEED FOR PERIODONTAL SURGERY COMPARED TO DEBRIDEMENT ALONE.

27.

  • Mechanism of action:
    • Bactericidal antimicrobial
    • Disrupts DNA synthesis leading to cell death
    • Selectively kills bacterial associated with periodontal disease
    • Susceptible bacteria include:
      • Fusobacterium, Bacteroides
      • Peptostreptococcus
      • Treponema, Campylobacter
      • Veillonella

28.

  • Clinical Considerations:
    • GCF concentrations > blood serum levels
    • When combined with oral hygiene & debridement = beneficial effect on periodontitis
      • Periodontal surgery may not be necessary
    • Doxycycline may be substituted for metronidazole
      • If client cant abstain from alcohol

29. Before & AfterTreatment with Metronidazole

  • Probing depth of 6 mm-before
  • Tissue shrinkage -after

30. Before & After Treatment with Metronidazole

  • 6 mm probing depths
  • Surgery has not been required

31.

  • Some evidence of bone gain client 2.5 years after initial debridement and use of metronidazole

32.

  • Dosage:
    • 250 mg tid for 7-10 days
    • 500 mg bid for 1-2 weeks
  • Doxycycline
    • 100 mg per day or BID
  • Metronidazole and amoxicillin or Augmentin
    • 250 mg(of each) TID for 7-10 days

33. AntibioticProphylaxis (Prevention)

  • Bacterial Endocarditis.
  • Prosthetic Joint Infections.
  • Immuno-Compromised Hosts.
  • Procedures and others.

34. SBE PROPHYLAXIS

  • RECOMMENDED