Local/Systemic Antimicrobials Perio Flashcards
What are BSP guidelines?
Antimicrobials little place in routine period tx
Increase resistance antibiotics - limit use
Drainage infection and removal cause still pertinent
Avoid use it pt who are systemically well
Indication/ role systemic antimicrobials?
- Aggressive form disease e.g young pt w/ rapidly progressive disease
- Necrotising forms of disease
- Possible: perio abscess and deep pocket not responding RSD
Examples of antimicrobials for systemic use?
- Tetracycline - historical
- Metronidazole - necrotising types
- Combination metronidazole and amoxicillin
- Azithromycin
What antimicrobial is used STH and when?
Azithromycin
Motivated pt w/ low plaque score and good OHI
ADJUNCT MECHANICAL TX
Give 2 antimicrobial tx options for rapidly progressive perio and discuss pro/cons
- Metronidazole 400mg + amoxicillin 500mg - TDS 7 days
- -> Problem w/ compliance due large dose/ frequency - Azithromycin 500mg daily 3 days
- -> Increased pt compliance
How treat deep pockets not responding tx?
- Combination metronidazole and amoxicillin
- Azithromycin
- Consider antibiotics sensitivity testing
Tx of periodontal abscess?
What is the gold standard antimicrobial of choice?
As adjunct to mechanical therapy - and only in some cases (pt systemically unwell)
- Metronidazole - gold standard
- Amoxicillin/ clavulanic acid or azithromycin
Tx necrotising perio?
- Metronidazole
Often associated w/ systemic features - justified
Main warnings re: azithromycin?
- Prolong QTc interval - increase risk abnormal heart rhythm
- Interaction w/ statins
Adv and disadv of antimicrobials?
Adv:
- Useful progressive/ aggressive cases
- Used multiple sites
- Low cost
- Reduce clinical time
Disadv
- Need pt compliance
- Unwanted side effect
- Sensitivity/ allergy issues
- Antim resistance
Give examples of locally applied antimicrobials?
Elyzol -metronidazole
PerioChip - chlorhexidine
Indications and disadvantages of using locally applied antimicrobials?
Indications
- Few sites
- Poor response debridement
- Deep pocket maintenance pt
Disadv
- Problem w/ washing away
- Hard apply deep pockets
What % of antimicrobial is in elyzol and what is it?
25% metronidazole
What state is elyzol?
Semi-solid suspension gel
Forms liquid crystal on contact with water
How to use elyzol?
Debride pocket first
Syringe into pocket until overflowing - wipe excess
Reapply 1 week later
Effectiveness elyzol?
Effective [a.m] less 1 day
Substantial amount swallowed
Does reduce PD and BOP
Use as adjunct to enhance tx
Contraindications of elyzol?
Pt w/ sesame seed allergy
Better for slowly progression perio -
don’t use aggressive/ refractory perio or perio in those with predisposing illness
What is PerioChip and how does it work?
Chlorhexidine digluconate 2.5mg in gelatine
Biodegrades releasing chlorhexidine over 7-10days
What is the minimum depth for use of PerioChip ?
> 5mm
2 examples of locally applied antimicrobials not used in UK
- Minocycline
2. Doxycycline
What is dentomycin?
A 2% minocycline for moderate to severe periodontitis used adjunct sites >5mm
Can’t repeat within 6 months
What is Atridox?
A 8.5% doxycycline
Gel that solidifies in pocket - isn’t flushed out and release for 7-10days
Absorbed and doens’t require removal
Enhance effect RSD and works in smokers
Adv and disadv of locally applied antimicrobials?
High local [a.m] w/ minimal side effects
Less reliance on pt compliance
Useful isolated sites
More expensive and effectiveness ?
Do local antimicrobials work?
Variation in studies
Additional improvement probing and clinical attachment vs RSD alone
Increase no. of sites w/ PD reduction > 2mm