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SP18: Perio MT1 > Role of Antibiotics > Flashcards

Role of Antibiotics Flashcards

1
Q

What are some potential indications for systemic antibiotics in perio disease?

A
  1. Aggressive periodontitis
  2. Severe perio abscess
  3. Severe NUG
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2
Q

Which bacteria in the subgingival biofilm indicate the use of antibiotics?

A

P. gingivalis and A.a.

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3
Q

T/F: Antibiotics can be useful because deep pockets can be hard to reach, and some bacteria enter the soft tissue.

A

True

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4
Q

T/F: Antibiotics can be effective without SRP.

A

False

Biofilm is resistant to antibiotics if not disrupted by SRP

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5
Q

T/F: Bacteria that invade into host tissue are removed with SRP.

A

False

This is where antibiotics can help

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6
Q

What is the difference between a bactericidal agent and a bacteriostatic agent?

A

Bactericidal: kills bacteria (homiCIDE, suiCIDE)

Bacteriostatic: slows bacterial growth

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7
Q

T/F: Broad spectrum antibiotics are preferred for treating periodontitis.

A

False

Narrow-spectrum are preferred because they spare gut bacteria

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8
Q

T/F: Penicillins kill bacteria.

A

True

But not effective against all A. a. strains

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9
Q

Penicillins are inactivated by _________.

A

Beta-lactamases

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10
Q

T/F: Penicillins are very good at penetrating epithelium.

A

False

Effective in gingival fluid

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11
Q

__________ is a penicillin with broad spectrum, enhanced tissue penetration, and is effective against gram negative bacteria.

A

Amoxicillin

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12
Q

_________ is amoxicillin with a beta-lactamase inhibitor.

A

Augmentin

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13
Q

Which part of the bacteria do penicillins act on?

A

Cell wall

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14
Q

_________ is a narrow-spectrum bactericidal agent that is active against strict anaerobes.

A

Metronidazole

Not as active against A. a.

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15
Q

T/F: Tetracyclines are bacteriostatic, broad-spectrum antibiotics.

A

True

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16
Q

Tetracyclines inhibit ________ which mediates collagen breakdown in periodontitis.

A

collagenase

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17
Q

What makes tetracyclines a strong candidate for periodontal antibiotic therapy?

A
  1. Inhibits collagenase

2. Occumulated by epithelial cells, gingival fibroblasts, and PMNs

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18
Q

How does tetracycline act on a bacterial cell?

A

Inhibits protein synthesis (30S inhibitor)

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19
Q

Minocycline and doxycycline are both examples of _________.

A

tetracyclines

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20
Q

T/F: Fluorquinolones are bacteriostatic.

A

False

Bacteridical

21
Q

When would you prescribe a patient with ciprofloxacin?

A

It is a fluoroquinolone so it is very active against A. a.

So in a patient with aggressive periodontitis it would be very effective

22
Q

T/F: Ciprofloxacin (fluoroquinolone) can penetrate epithelial cells and phagocytes and can kill invasive bacteria.

A

True

23
Q

How does clindamycin act on a bacterial cell?

A

Inhibits protein synthesis (50S inhibitor)

24
Q

T/F: Clindamycin would be a good antibiotic for a patient with aggressive periodontitis.

A

False

Not effective against A. a.

25
Q

What is a negative side effect specific to clindamycin?

A

Can induce ulcerative colitis

26
Q

T/F: Clindamycin is often used in patients who are allergic to penicillin.

A

True

27
Q

Azithromycin and clarithromycin are both ________.

A

Macrolides

28
Q

Macrolides are ____ inhibitors.

A

50S

29
Q

What are the advantages of macrolides?

A
  1. Good activity against A. a., P. g., and other gram-negative anaerobes
  2. Penetrates epithelial tissues
  3. Bactericidal
  4. Anti-inflammatory
  5. Simple regimen
30
Q

What is the major downside of prescribing macrolides?

A

Expensive

31
Q

T/F: Macrolides like clarithromycin reach higher levels in inflamed gingiva than in healthy gingiva.

A

True

32
Q

What are some common features of tetracyclines, ciprofloxacin, azithromycin, and clarithromycin?

A
  1. Levels in gingival crevicular fluid are often higher than levels in blood
  2. Actively accumulated by PMNs, fibroblasts, and oral epithelium
  3. Can kill invasive bacteria
33
Q

Amoxicillin and metronidazole are both ________ agents. But doxycycline and azithromycin are both ________ agents.

A

bactericidal; bacteriostatic

34
Q

T/F: Molecular tests for specific bacteria are more sensitive than culture methods.

A

True

35
Q

T/F: Molecular tests for specific bacteria require live bacterial cells.

A

False

Just DNA

36
Q

What are the major downsides of bacterial culturing?

A
  1. Logistics (cost, transport, availability)
  2. Not very sensitive
  3. Difficult to grow spirochetes
37
Q

When would you want to utilize a microbiological test?

A

After a poor response to initial therapy

38
Q

What is the preferred regimen for aggressive periodontitis or severe chronic periodontitis?

A

Amoxicillin (500mg TID) combined with metronidazole (250mg TID) for 8 days

39
Q

What are two alternative regimens for patients with penicllin allergies?

A
  1. Azithromycin (500mg starting dose, then 250mg/day for 4 days)
  2. Metronidazole (500mg TID for 7 days)
40
Q

Antibiotic therapy is most beneficial for patients …..

A

with deep pockets who are unresponsive to initial treatment, or who have aggressive periodontitis

41
Q

T/F: Antibiotics are just as effective on patients who undergo surgical therapy as those who undergo non-surgical therapy.

A

False

Benefits are greater in patients with non-surgical therapy

42
Q

What are the major limitations of antibiotics in periodontics?

A
  1. Not effective without SRP

2. Undesirable side effects

43
Q

What are some general side effects that can be associated with systemic antibiotics?

A
  1. Induce resistance
  2. Microbial overgrowth
  3. Hypersesisitivity/toxicity
44
Q

Dental staining is a side effect often seen with _______.

A

tetracyclines

45
Q

Altered taste is a common side effect seen with ______.

A

metronidazole

46
Q

Cholestatic jaundice and cardiac arrhythmia are rare side effects associated with _________.

A

azithromycin

47
Q

T/F: Dentists can help prevent inducing antibiotic resistance by prescribing broad-spectrum antibiotics and telling patients to only use them until their symptoms are gone.

A

False

Use narrow-spectrum and have patient take the full dosage

48
Q

What are the shortcomings of local delivery of antibiotics?

A
  1. Less effective at eradicating invasive bacteria
  2. Recurrent infection from other parts of the mouth
  3. Time consuming and not cost-effective
49
Q

What is the current application for local antibiotic delivery?

A

Treatment of localized recurrent periodontitis in cases that are otherwise stable

SP18: Perio MT1 (8 decks)

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