EXAM I Systemic Antibiotics Flashcards
what are the clinical benefits of chemotherapeutic agents?
- antimicrobial actions
- ability to increase the host’s resistance
what are 3 categories of chemotherapeutics?
- systemic antibiotics
- controlled drug delivery systems
- drugs that modulate host response
there is no evidence that antibiotics alone can arrest periodontal disease. systemic antibiotics have the greatest benefit in what 4 areas?
- the presence of systemic disease
- immunocompromised patients
- aggressive forms of periodontal disease
- patients who are not good candidates for more complex and invasive treatment
what are the 5 guidelines for the use of antibiotics in periodontal therapy?
- the clinical diagnosis and situation dictate the need for possible antibiotic therapy as an adjunct in controlling active periodontal disease
- chronic periodontitis can and should be treated initially without systemic antibiotics
- antibiotics are selected based on the microbial composition of the plaque, patients medical status, and current medications
- the use of culture sensitivity testing provides valuable information regarding the appropriate selection of antibiotics
- antibiotic therapy should not be used as a monotherapy. it should be a part of a comprehensive periodontal treatment plan
periodontal disease is predominantly a gram positive or negative infection? aerobic or anaerobic?
gram negative anaerobic infection
in periodontal disease, antimicrobials targeting which spectrum are beneficial?
gram negative anaerobic bacteria
what is a disadvantage of culture and sensitivity tests for periodontal disease?
they are expensive
in a study of chronic periodontitis with the use of antibiotics, microbiologic testing yielded excellent clinical results regardless of the presence or absence of which six classic periodontal periopathogens prior to treatment?
- Aggregatibacter actinomycetemcomitans [previously Actinobacillus actinomycetemcomitans]
- Fusobacterium nucleatum spp.
- Porphyromonas gingivalis
- Prevotella intermedia
- Treponema denticola
- Tannerella forsythia [previously T. forsythensis]
what are some general indications for the use of antibiotics in periodontal therapy?
- patients nonresponsive to conventional therapy
- acute periodontal infections with systemic manifestations
- prophylaxis in medically compromised patients
- adjunct to surgical and nonsurgical periodontal therapy
in what 7 situations should you consider the use of systemic antibiotics during periodontal therapy?
- aggressive periodontitis
- necrotizing ulcerative periodontal disease
- refractory periodontitis, or patients who are considered to be high risk
- generalized severe chronic periodontitis
- periodontal patients who are immunocompromised
- heavy smokers
- in conjunction with certain surgical procedures (implants, bone grafting, sinus lifts, guided tissue regeneration)
what is the mechanicms of action, spectrum, and effect of penicillins?
- mechanism of action: inhibits cell wall synthesis
- spectrum: narrow
- effect: bacteriocidal
which 3 penicillins are frequently use in periodontal therapy?
- amoxicillin
- pen VK
- amoxicillin with clavulanic acid (augmentin)
what is the mechanicms of action, spectrum, and effect of tetracyclines?
- mechanism of action: inhibits protein synthesis
- spectrum: broad spectrum
- effect: bacteriostatic
what are indications for the use of tetracyclines?
- refractory periodontitis
- aggressive periodontitis (EOP)
what are 2 advantages of tetracyclines?
- ability to concentrate in the tissues and destroy A.a.
- anticollegenase activity
what are 3 contraindications of tetracyclines?
- should not be given with milk and dairy products, FE++ containing vitamins and minerals, or antacids
- absorption of tetracyclines is impaired by Ca++, Fe++, Mg++, and Al+++
- photosensitivity (sensitivity to light)
- avoid use in children, pregnant/nursing mothers (may cause discoloration of teeth)
what are the 2 forms of tetracyclines used in periodontal therapy?
- doxycycline
- minocycline
describe doxycycline
- semi-synthetic tetracycline
- easier on the stomach than minocycline or tetracycline
- can take with dairy products
- decreased side effects vs. tetra- or minocycline
what is the common regimen for doxycycline?
- Rx: doxycycline 100 mg
- disp: #22
- sig: 2 caps stat, then 1 cap QD for 21 days