43.Antibiotics in periodontal therapy Flashcards
Antibiotics in periodontal therapy
Effectiveness of antibiotic therapy depends on
- Capacity of drug to reach infected site
- Resistance of bacteria/ability to inactivate agent
- Be maintained at sufficienty high concentration for some time
Antibiotics in periodontal therapy
Antibiotics classified into
- Bacteriostatic and bactericidal
- Narrow spectrum and wide spectrum
Antibiotics in periodontal therapy
Must always precede antimicrobial therapy
Mechanical instrumentation
Antibiotics in periodontal therapy
Methods of delivery of antibiotics
- Oral
- Intramuscular/intravenous(serious conditions)
- Topical
Antibiotics in periodontal therapy
Allows application of antimicrobial agents at levels that cannot be reached by systemic route
Local therapy
Antibiotics in periodontal therapy
Systemic antiobiotics better if
Targeted bacteria are distributed wider
Antibiotics in periodontal therapy
Disadvantages of systemic antibiotic therapy
- Only small portion reaches subgingival microflora
- Adverse drug reactions greater
Antibiotics in periodontal therapy
Tetracylines
- Refractory periodontitis, incl. localised aggresive periodontitis
- Bacteriostatic=>effective against gram positive bacteria
- Anti-collagenase effect
- Inhibts growth of A.A
Antibiotics in periodontal therapy
Anticollagenase effect
Inhibits tissue destruction and helps with bone regeneration
Antibiotics in periodontal therapy
Can be used due to increased resistance to tetracyclines
- Metranidazole
- Metranidazole-clavulanic acid
Antibiotics in periodontal therapy
Reason long term use of tetracyclines should be avoided
- Bacterial resistance
Antibiotics in periodontal therapy
Members of tetracycline group
- Tetracycline
- Minocycline
- Doxycyline
Antibiotics in periodontal therapy
side effects of Tetracycline use
- Photosensitivity
- Dizziness
- Headache
- Tooth discolouration (under12)
Antibiotics in periodontal therapy
Minocycline
- Broad spectrum
- Suppresses spirochetes and motile rods
- Similar side effects to tetracycline but increased incidence of vertigo
Antibiotics in periodontal therapy
Doxycycline
- Broad spectrum(similar to minocycline)
- Similar side effects to tetracycline
Antibiotics in periodontal therapy
Most photosensitising agent in tetracycline category
Doxycycline
Antibiotics in periodontal therapy
Metranidazole
- Bactericidal
- Effective against anaerobes-porphyromonas gingivalis and prevotella intermedia
- Uses-Gingivitis, ANUG, Chronic and aggressive periodontitis
Antibiotics in periodontal therapy
Metranidazole can be combined with
- Amoxicilin
- Amoxicilin clavulanate
Antibiotics in periodontal therapy
Metranidazole side effects
- Antabuse effect when alcohol ingested- Cramps, nausea, vomitting
- Inhibits warfarin metabolism
- Prolongs prothrombin time
- Metallic taste in mouth
Antibiotics in periodontal therapy
Most widley used antibiotic
Penicillins
Antibiotics in periodontal therapy
Penicillins
- Bactericidal
- Inhibit bacterial cell wall production
Antibiotics in periodontal therapy
Side effects of penicillins
- Allergic reactions
- Bacterial resistance
Antibiotics in periodontal therapy
Amoxicillin
- Semi synthetic penicillin
- Gram negative and positive bacteria
- Aggressive periodontitis
- Susceptible to penicillinase
Antibiotics in periodontal therapy
Penicillinase
*Beta lactamase that breaks penicillin ring structure=>
* Makes it ineffective
Antibiotics in periodontal therapy
Combination of amoxicilin that is resistant to penicilinase enzymes
Amoxicillin-clavulanate potassium
Antibiotics in periodontal therapy
Beta lactams with similar action and structure to penicillins
Cephalosporins
Antibiotics in periodontal therapy
Cephalosporins
- Resistant to Betalactamases
- Not usually used for dental infections
Antibiotics in periodontal therapy
Clindamycin
- Anaerobic bacteria
- Periodontitis
- Strong affinity for osseous tissue
Antibiotics in periodontal therapy
Ciprofloxacin
- Quinolone=>gram negative rods
- All strains of A.A
- Minimal effect on streptococcus species
- Can be combined w/ metronidazole
Antibiotics in periodontal therapy
Macrolides
- Inhibit protein synthesis
- Bacteriostatic and bacteriocidial
- Erythromycin, spiramycin, azithromycin
Antibiotics in periodontal therapy
Can alter electrical activity of heart leading to prolonged QT interval
Azithromycin
Antibiotics in periodontal therapy
Amoxicilin dose
- 500mg
- x3 a day for 8 days
Antibiotics in periodontal therapy
Azithromycin dose
- 500 mg
- x1 daily for 4-7 days
Antibiotics in periodontal therapy
Ciprofloxacin dose
- 500 mg
- X2 daily for 8 days
Antibiotics in periodontal therapy
Clindamycin dose
- 300 mg
- x3 daily for 10 days
Antibiotics in periodontal therapy
Doxycyline and minocycline dose
- 100 mg to 200 mg
- x1 daily for 21 days
Antibiotics in periodontal therapy
Metronidazole dose
- 500 mg
- x3 daily for 8 days
