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Antibiotics
Chemotherapeutic agents can be administered
orally,
locally
or
parenterally
In order to reduce no.of bacteria present in P.,
systemic antibiotic
may be a necessary
adjunct in controlling bact.infection because
the bacteria can invade the soft t.making
mechanical therapy alone ineffective
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Local administration of antimicrobial agents
directly in pocket provide;
greater conc.to infected area &
reduce possible systemic side effects
Guidelines for use of AB in p.d.therapy
Clinical diagnosis & situation dictate the need
for AB as an adjunct in active disease as
change in course of disease from active to
health or to refractory
Continuing disease activity
(LA, exudate, p.of 5mm & more with BOP) are
an indications for microbial analysis & further
p.d. therapy
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AB selected based on
microbial composition of plaque,
pt.medical status
& current medication
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Sampling done by taking a sample at the
beginning of appointment before
instrumentation of pocket;
1
st
of all
supragingival plaque is removed, then
paper point is inserted subgingivally to absorb
bact.in loosely associated plaque later on
placed in reduced transfer fluid & sent
overnight to lab.
P.sampling performed at initial examination ,RP,
reevaluation or supportive therapy,
as clinical indication for testing;
1. Aggressive p.d.
2. Refractory to mechanical debridment &
3. p.d.associated with systemic disease
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AB have a value to reduce need for
p.d.surgery in pt.with chronic p.d.
Sh.
not
be used as a
monotherapy
but a part of full regimen
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The treatment of periodontal diseases by antimicrobial agents alone will probably
not
suffice and indicate that mechanical instrumentation
to disrupt the biofilm and to remove the bulk of bacterial deposits must precede
antimicrobial therapy
.
adjuncts
chemotherapeutic
Include
1. Subgingival antimicrobial agent,
2. Subgingival ultrasonic irrigation with
antiseptic during RP
3. chx rinse after debridment for 2 w.
4. Home intraoral irrigation with or
without antibacterial agent
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Chx
effective as an antiplaque agent but its
antimicrobial activity is greatly reduce in presence of
organic matter in subgingival p.d.pocket
Povidine iodine
effective antibacterial agent when used
directly into p.d.pocket even with low concentration
but use with caution in pt.sensitive to iodine,
althouth sensitization rate is low, use with precaution
in pregnant & lactating pt.
Its preferable to start AB given
1-2 days
before
surgery & continuing for a total of at least
8
days
Topical application of AB through
mouthwash & dentifrice ineffective ?
1- transient time of contact b/w drugs &
tissues
2- lack of penetration into p.
3- risk of hypersensitivity
4- appearance of resistant m.o.
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Drugs that used in periodontal
diseases
Penicillin
Induce p.inhibition but not used for p.control as B-
lactamase enzyme found in p.d.pocket
10% of pt.allergic to P.
Amoxicillin
useful in treatment of aggressive p.d with dose of 500 *
3 for 8d.
Amoxil-clavulanate
used for refractory & aggressive p.d.
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Tetracycline
Systemic administration of tetracycline cause
arrest of bone loss ( aid bone regeneration by
removal of m.o.) & slight alteration of
composition of p.microbiota
Recolonization occur within
6-16 w
following
cessation of treatment,
Tetracycline
high level of tetra.-resistant mostly G+ve
cocci develop,
also no benefit of it over mechanical
debridment
so
not used routinely for
p.d.treatment
بس المشكلة
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Tetracycline
Tetracycline used for treatment of certain
p.d.disease as its conc.is high in G.fluid (
2-10
times that in serum) & adsorb to root then
release slowly in active form as it has high
affinity to hydroxy apetite crystal
Tetracycline cap.250mg*4 for 2w.given as adjunct
to local debridment in localized aggressive p.d.
Tetracycline
Tetracycline effective against G+ve (more)
& G-ve m.o. include A.a.
(
broad spectrum &
bacteriostatic
),
reduce bone & C.breakdown through its
ability to inhibit collagenase
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Tetracycline
Contraindication;
sever liver or kidney dysfunction
Tet.ointment 1%
used in
1. acute pocket exacerbation,
2. under p.d.dressing,
3. in combination with orabase to cover aphthus
Tet.now tend to be replaced by more effective
combination AB
Tetracycline
Specific
agents
;
Tetracycline,Menocycline & Doxycycline
semi synthetic members of tetracycline gp.
used in p.d.disease
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Minocycline
suppress spirochetes & motile rod for up to
3 m
,
given twice a day (200mg/d.) for 1w.result in
reduction in total bacterial count ,
complete elimination of spirochetes for up to
2m
.
Doxycycline
given with single dose 100mg cap.twice daily
in 1st day then once a day
To reduce GIT upset 50mg can be taken
twice daily
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Metranidazole
Highly effective against G-ve anaerobic
m.o. & spirochetes
so can be used in
Aggressive pd
Advanced pd
Refractory pd
NUG
Metranidazole
Reduction of p.depth with reduction of no.
of
bacteroid
,
capnocytophaga
,
p.g.
&
p.i.
Adjunct to S. & RP,
also result in reduce need for surgery
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Metranidazole
Its combination with amoxicillin given for patients with
aggressive & advanced chronic p.d.to induce
synergistic effect lead to complete elimination of
A.a.for long period
(50% harbored
A.a. after 1y.)
Bactericidal effect
cant be used
for pt.with CNS disorder, blood dyscrasias
(prolong prothrombine time) & 1
st
trimester of
pregnancy
Clindamycin
Effective against anaerobic bacteria ,in situation
in which pt.allergic to penicillin
Used in refractory p.d.150mg,twice daily for 10
days or 300mg twice daily for 8days
Side effect;
pseudomembranous
colitis
,diarrhea
or cramping are indication of such problem so
advise the pt to discontinue taking of drug
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Ciprofloxacin
Is a quinolone active against G.-ve rods including
all facultative & some anaerobic putative
p.d.pathogen
Its only AB to which all strain of A.a.are susceptible
Common AB regimens used in treatment of
p.d.disease
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mitronidazole/ act on obligate anaerobic
Ciprofloxacin act on facultative anaerobic
They have therapeutic & prophylactic benefits
by giving rise to strept.microflora
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Local delivery drugs
Local delivery of AB
By targeting an antimicrobial to infected sites
& sustaining its localized concentration
at effective levels for sufficient time
while concurrently induce minimal or no
side effects
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Tetracycline-containing fibres (actisite)
F.with diameter 0.5mm contain tetracycline
(
12.7mg/9 inches
) packed into p.d.pocket
Its well tolerated by oral t. & for
10 d
.it sustains
tet.conc.exceeding
1300mg/ml
No change in AB resistant
Disadvantage
take long time for placement( 10min./tooth) &
need for 2
nd
appointment to remove it
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Subg.delivery of doxycycline (Atridox)
Gel system that incorporates
the AB doxycycline(10%)
in syringeable gel system
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Subg.delivery system for
minocycline(dentamycin & periocline)
Syringeable gel suspension
delivery formulation
that deliver 2% minocycline HCL
to p.d.pocket
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Subg.delivery of metranidazol
Topical medication containing
an oil-based met.25% dental gel
applied in viscous consistency to p
.where two 25% gel application
at a 1w.interval used in clinical studies