1.23 Chemotherapeutics Flashcards
When should systemic antibiotics be used? (When doing SRP for periodontitis)
Loesche & Giordano ‘94
Compared:
* After the first SRP
* After the last SRP
Antibiotics after the last SRP had the most benefit in deep pockets and reduced the need for surgery
* SRP + Abx group: needed surgery on 2.4 teeth/pt
* SRP only group: surgery on 7.1 teeth/pt
When should amoxicillin + metronidazole be used in aggressive periodontitis patients?
Griffiths 2011
Patients from 18-35 years old and PD ≥5mm
Dosage: Amoxicillin 500mg + Metronidazole 500mg. Both 3x/day for 7 days
Findings: Using the antibiotics at the initial therapy had better results than at retreatment. (And antibiotics at any time had better results than no antibiotics)
- Deep pockets (7+mm): abx group had 1mm less PD
- Moderate pockets (4-6mm): abx group had 0.5 mm less PD
Describe the Slots & Rams 1990 article
Slots & Rams 1990
A narrative review discussing antibiotics knowledge of the time.
The authors recommend microbial susceptibility testing whenever doing antibiotics. They also described pros and cons of systemic vs. local antibiotics:
Systemics:
* (+) can reach deeper layers of biofilm since it travels in the blood serum
* (-) lower concentrations at sites compared to local antibiotics
Locals:
* (+) reaches concentrations 100x greater at the site, compared to systemic antibiotics
* (-) reinfection may occur if bacterial reservoirs exist elsewhere in the body.
What are the indications for antibiotic therapy?
- Refractory periodontitis
- Acute periodontal abscesses / infections
- Aggressive periodontitis
- Stage IV periodontitis
- Immunosuppressed patients
- As an adjunct to SRP
How much will CAL improve if you add antibiotics to SRP?
Smiley 2015
SRP with antibiotics:
CAL +0.2 - 0.6
(compared to SRP only)
Does antibiotics with SRP benefit Type 2 Diabetic patients?
Miranda 2014
Yes = specifically, Amoxicillin & Metronidazole.
Better clinical results (CAL, PD, and fewer sites ≥5 mm)
Amoxicillin: 500 mg TID
Metronidazole: 400 mg TID
Both for 14 days
Is there a benefit of prescribing antibiotics in smokers with periodontitis?
Angaji 2010
Evidence is inconclusive; more data is needed.
However, there appears to be an association with antibiotics providing benefit.
Who described the specific plaque hypotheses?
Loesche 1975 - specific bacteria cause disease
Socransky & Haffajee 1998 - analyzed subgingival plaque samples via DNA probes and checkerboard analyses. Certain bacterial “groups” were found = red complex, green complex, orange complex, etc.
Does metronidazole + SRP offer any benefits, compared to SRP alone?
Loesche 1992
Yes: Adding Metronidazole 250 TID for 1 week to SRP will reduce the need for surgery in patients.
* 62% reduction in surgery in metronidazole group (versus 21% reduction in SRP only group)
This was an RCT with 33 total BANA (+) periodontitis patients. Metronidazole was started after last session of SRP.
* Greatest improvement is seen in deep pockets (≥7mm).
What is the best combination of antibiotics for periodontits treatment?
Systematic reviews by Herrera 2002 and Teughels 2006 recommend metronidazole + amoxicillin.
Usually, doses are:
* Metronidazole 250-500mg TID
* Amoxicillin 500mg TID
Teughels 2006: 28 RCTs. Metro + amoxicillin had the greatest success in PD reduction and Pocket closures.
Antibiotics that were examined: 1- Azithromycin 2- Clarithromycin 3- Metronidazole 4-Metronidazole and Amoxicillin (most frequently reported on), others 5-Tetracycline 6-Ornidazole 7-Spiramycin 8-Minocycline 9- Amoxicillin alone.
What is the van Winkelhoff cocktail?
van Winkelhoff 1992
Amoxicillin 500 mg TID for 7 days
+
Metronidazole 250 mg TID for 7 days
This combination is great for reducing Aa bacteria in severe periodontitis patients
McGowan 2018 - recommended a slightly higher dose (400 or 500 mg TID metronidazole)
What study looked at nonsurgical therapy & azithromycin in smokers?
Mascarenhas 2005
Michigan study with Dr. Wang
Compared SRP vs. SRP + azithromycin
Dose: Azithromycin 500mg on the 1st day, followed by 250mg / day for 4 days.
Finding: Adding azithromycin to SRP was beneficial to smokers. (+0.5 mm more CAL in the antibiotic group, compared to SRP only group).
What study looked at surgical therapy & azithromycin in smokers?
Dastoor 2007
Michigan study with Dr. Wang
Compared:
* surgical therapy only
* surgical therapy + 500 mg azithromycin daily for 3 days
Finding: No additional benefit of adding azithromycin to the surgery.
Is there a benefit of adding tetracyclines to SRP?
Ramberg 2001: There was a short-term benefit on CAL gain (in the 1st year), but no changes in PD or BOP.
If you add antibiotics to the Surgical treatment of peri-implantitis, is there a benefit?
This is an area of ongoing research. However:
Carcuac 2016 showed some benefit of abx.
RCT
Each group had surgery of the implant. In addition:
* (Group 1): 750 mg amoxicillin twice daily. Started 3 days prior to surgery and continued for 10 days.
* (Group 2): local chlorhexidine
* (Group 3): only surgery
Findings: Local Chlorhexidine during surgery added no benefit. Antibiotics seemed to add benefit if implants had a modified surface. However, more research is needed.
