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IODC - Periodontology > Local/Systemic Antimicrobials Perio > Flashcards

Local/Systemic Antimicrobials Perio Flashcards

1
Q

What are BSP guidelines?

A

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

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2
Q

Indication/ role systemic antimicrobials?

A
  1. Aggressive form disease e.g young pt w/ rapidly progressive disease
  2. Necrotising forms of disease
  3. Possible: perio abscess and deep pocket not responding RSD
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3
Q

Examples of antimicrobials for systemic use?

A
  1. Tetracycline - historical
  2. Metronidazole - necrotising types
  3. Combination metronidazole and amoxicillin
  4. Azithromycin
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4
Q

What antimicrobial is used STH and when?

A

Azithromycin
Motivated pt w/ low plaque score and good OHI
ADJUNCT MECHANICAL TX

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5
Q

Give 2 antimicrobial tx options for rapidly progressive perio and discuss pro/cons

A
  1. Metronidazole 400mg + amoxicillin 500mg - TDS 7 days
    - -> Problem w/ compliance due large dose/ frequency
  2. Azithromycin 500mg daily 3 days
    - -> Increased pt compliance
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6
Q

How treat deep pockets not responding tx?

A
  1. Combination metronidazole and amoxicillin
  2. Azithromycin
  3. Consider antibiotics sensitivity testing
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7
Q

Tx of periodontal abscess?

What is the gold standard antimicrobial of choice?

A

As adjunct to mechanical therapy - and only in some cases (pt systemically unwell)

  1. Metronidazole - gold standard
  2. Amoxicillin/ clavulanic acid or azithromycin
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8
Q

Tx necrotising perio?

A
  1. Metronidazole

Often associated w/ systemic features - justified

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9
Q

Main warnings re: azithromycin?

A
  1. Prolong QTc interval - increase risk abnormal heart rhythm
  2. Interaction w/ statins
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10
Q

Adv and disadv of antimicrobials?

A

Adv:

  1. Useful progressive/ aggressive cases
  2. Used multiple sites
  3. Low cost
  4. Reduce clinical time

Disadv

  1. Need pt compliance
  2. Unwanted side effect
  3. Sensitivity/ allergy issues
  4. Antim resistance
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11
Q

Give examples of locally applied antimicrobials?

A

Elyzol -metronidazole

PerioChip - chlorhexidine

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12
Q

Indications and disadvantages of using locally applied antimicrobials?

A

Indications

  1. Few sites
  2. Poor response debridement
  3. Deep pocket maintenance pt

Disadv

  1. Problem w/ washing away
  2. Hard apply deep pockets
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13
Q

What % of antimicrobial is in elyzol and what is it?

A

25% metronidazole

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14
Q

What state is elyzol?

A

Semi-solid suspension gel

Forms liquid crystal on contact with water

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15
Q

How to use elyzol?

A

Debride pocket first
Syringe into pocket until overflowing - wipe excess
Reapply 1 week later

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16
Q

Effectiveness elyzol?

A

Effective [a.m] less 1 day
Substantial amount swallowed
Does reduce PD and BOP
Use as adjunct to enhance tx

17
Q

Contraindications of elyzol?

A

Pt w/ sesame seed allergy

Better for slowly progression perio -
don’t use aggressive/ refractory perio or perio in those with predisposing illness

18
Q

What is PerioChip and how does it work?

A

Chlorhexidine digluconate 2.5mg in gelatine

Biodegrades releasing chlorhexidine over 7-10days

19
Q

What is the minimum depth for use of PerioChip ?

A

> 5mm

20
Q

2 examples of locally applied antimicrobials not used in UK

A
  1. Minocycline

2. Doxycycline

21
Q

What is dentomycin?

A

A 2% minocycline for moderate to severe periodontitis used adjunct sites >5mm
Can’t repeat within 6 months

22
Q

What is Atridox?

A

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

23
Q

Adv and disadv of locally applied antimicrobials?

A

High local [a.m] w/ minimal side effects
Less reliance on pt compliance
Useful isolated sites

More expensive and effectiveness ?

24
Q

Do local antimicrobials work?

A

Variation in studies
Additional improvement probing and clinical attachment vs RSD alone
Increase no. of sites w/ PD reduction > 2mm

IODC - Periodontology (8 decks)

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