ADJUNCTIVE ANTIBIOTIC TREATMENT

Question 1

a. What are the clinical indications for the prescription of antibiotics in the treatment of periodontal treatment? (3)

Answer 1

Question 2

b. What clinical conditions would need to be achieved in order for the prescription of antibiotics to achieve its maximum effect? (6)

Answer 2

• Systemic antimicrobials are more effective when the biofilm has been disrupted and still is not reorganized, which implies that the needed debridement should be carried out in the shortest possible time span (approximately 1 week) so as to achieve effective drug serum levels on the day of the completion of debridement.
• Mechanical biofilm disruption must be always combined with effective supragingival plaque control by the patient.
• Antibiotic intake should start on the day of debridement completion; it should be completed within a short time and with an adequate quality.
• Reduction in the bacterial load as much as possible prior to the administration of antibiotic therapy.
• Pre-treatment analysis of microbial composition to select the optimal antibacterial drug.
• Patients medical and dental history should be taken into consideration such as current medications to avoid adverse interactions and also strengthen the effect of the antibiotic

Question 3

c. What additional clinical benefits can the prescription of antibiotics bring? (2)

Answer 3

 Reduce the chances of bacterial migration from one pocket to the other.

Question 4

d. What are the advantages and disadvantages of prescribing a combination of different

antibiotics in the treatment of periodontal diseases? (5)

Answer 4

• Advantages
  
  • Overlaps in the antimicrobial spectrums of different agents may reduce the possible development of bacterial resistance.
  • Some combinations of drugs have a synergistic action against target organisms, allowing lower doses of the single agents to be used
  • Overcome the drug protective effects of the biofilm
• Disadvantages
  
  • Some drugs may interact antagonistically

Question 5

e. You are advised to prescribe Metronidazole and amoxicillin as adjunctive antibiotic therapy. Fill in the prescription form. (4)

Answer 5

 Right dosage
 Days of prescription
 No. of tablets
 Type of drugs (Drug name)

Anson: See page 132 for prescription form

Question 6

2. List the systemic side effects of using combination of Amoxycillin and Metronidazole (4)

Answer 6