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SP15 Periodontology > Role of Antibiotics in Periodontal Therapy > Flashcards

Role of Antibiotics in Periodontal Therapy Flashcards

1
Q

What are six indications for systemic antibiotic therapy

A 
aggressive periodontitis
failing implants
periodontal abscess (sometimes)
NUG (sometimes)
recurrent periodontitis
poor general response to initial therapy
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2
Q

What is the rationale for using antibiotics

A

some periodontal pathogens (Aa, Pg, Pi) are invasive, making them difficult to eliminate by SRP

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3
Q

What is the measurement of a pocket that it pretty hard to clean out

A

≥ 5mm

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4
Q

Why is chronic periodontitis not routinely treatment with antibiotics (2 reasons)

A

root planing eliminates most subgingival bacteria associated with chronic periodontitis
host defense mechanisms are usually effective

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5
Q

Systemic antibiotics are potentially helpful in periodontal therapy if what four things occur

A

they distribute to the pocket and its soft tissue wall
they reach inhibitory levels in the pocket
their levels are maintained for an adequate duration
they penetrate host cells and kill invasive bacteria

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6
Q

Antibiotics are much more effective after this has been disrupted

A

biofilm

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7
Q

What is a narrow spectrum antibiotic

A

effective against specific families of bacteria

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8
Q

What is a broad spectrum antibiotic

A

acts against a wide range of clinically important bacteria

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9
Q

This is bactericidal, but inactivated by beta lactamases

A

penicillins

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10
Q

Where do penicillins reach effective levels

A

in the gingival fluid

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11
Q

Penicillins don’t inhibit all of these strains

A

Aa

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12
Q

Penicillins don’t penetrate what very well

A

epithelial cells

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13
Q

This has enhanced tissue penetration and good activity against gram negatives

A

amoxicillin

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14
Q

This is as effective as amoxicillin, and it is resistant to inactivation by beta lactamases

A

augmentin

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15
Q

This has bactericidal activity against strict anaerobes but has less potent activity against facultative bugs like Aa

A

metronidazole

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16
Q

This is bacteriostatic against most periodontal pathogens

A

tetracyclines

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17
Q

In which fluid does tetracyclines, doxycycline, and fluoroquinolones reach higher levels

A

gingival fluid compared to blood serum

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18
Q

tetracyclines inhibit this

A

collagenases; which mediates collagen breakdown in periodontitis

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19
Q

tetracyclines are actively accumulated by which cells

A

oral epithelial cells
gingival fibroblasts
PMNs

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20
Q

This is bactericidal and extremely active against Aa but less active against anaerobic bacteria like Pg

A

fluoroquinolones

21
Q

What is the mechanism of fluoroquinolones

A

penetrate epithelial cells and phagocytes and can kill invasive bacteria

22
Q

This appeared to enhance PMN bactericidal ability again Aa and is the most significant when the bacteria:PNM ratio is high

A

ciprofloxin

23
Q

This has potent bacteriostatic activity against strict anaerobes and is less effective against facultative pathogens like Aa

A

clindamycin

24
Q

These are not especially effective at concentrations seen in gingival fluid and has weak activity against Aa

A

macrolides (erythromycin)

25
Q

These can reach high concentrations in tissue, and has good activity against Aa, P gingivitis, and other gram (-) anaerobes

A

azithromycin

clarithromycin

26
Q

What is the mechanism of azithromycin and clarithromycin

A

penetrates epithelial cells and kills invasive bacteria; also taken up by PMNs and fibroblasts

27
Q

Macrolides (-mycin’s) produce what kind of effects

A

anti-inflammatory

28
Q

Azithryomycin induces a decrease in what

A

GCF IL-8 and TNF content in healthy subjects

29
Q

True or False

systemic clairthromycin reaches high levels in inflamed gingiva than in healthy gingiva

A

True

30
Q

True or False

Azithromycin does not help eliminate invasive Aa infection from cultured oral epithelium cells

A

False, it does

31
Q

In the presence of an overwhelming Aa infection these kill Aa more effectively

A

PMNs loaded with clarithromycin or azithromycin

32
Q

True or False

Antibiotics like cyclines, floxacin, and mycin’s can kill invasive bacteria

A

True

33
Q

What would an ideal concentration vs MIC in order for the antibiotics that treat periodontitis to be effective

A

10x concentration vs MIC

34
Q

What are three methods to determine which antibiotic to use

A

empirical approach, based on RCT data
identify pathogens at the site with a molecular technique then prescribe an antibiotic that will inhibit them
culture isolated bacteria to identify and then determine the susceptibility to antibiotics

35
Q

This permits detection of specific pathogens in subgingival plaque or saliva specimens; available as a reference lab service but not many available

A

molecular tests for microbial identification

36
Q

What are some advantages of molecular tests

A 
plaque/saliva easy to collect
non-invasive
test specific for bacteria
more sensitive
tests require DNA not live bacteria
37
Q

What are some advantages of bacterial culturing

A

reflects the viable bacteria in the pocket
can assess the predominance of a particular pathogen
can grow and study unusual bacteria
can determine antibiotic susceptibility

38
Q

What are some disadvantages of bacterial culturing

A 
few labs available
time consuming and costly
problems with transport
difficult to grow more organisms
accuracy depends on good sampling
not very sensitive
39
Q

What should be completed before microbiological testing

A

initial periodontal therapy, then assess the response, then prescribe if needed

40
Q

What are the typical antibiotic regimens for aggressive and recurrent periodontitis

A

amoxicillin and metronidazole

azithromycin for penicillin allergies

41
Q

systemic antibiotics are not consistently beneficial unless what

A

the biofilm is disrupted by SRP

42
Q

antibiotics enhance treatment of which type of periodontist more

A

aggressive

43
Q

Which should come first, antibiotics or SRP

A

SRP

44
Q

What are three adverse side effects associated with systemic antibiotics

A

induction of antibiotic resistance
induction of microbial overgrowth
hypersensitivity/toxicity

45
Q

This type of antibiotic delivery avoids most adverse side effects

A

local antibiotic delivery

46
Q

What are some advantages of local delivery of antibiotics

A

high drug concentration
sustained therapeutic levels
effective drug levels can be attained at sites that are difficult to reach adverse side effects are minimized

47
Q

What are some short comings of local delivery of antibiotics

A

less effective than systemic antibiotics at eradicating invasive bacteria
can’t eliminate pathogens from the entire oral cavity
local delivery technique can be time consuming and not cost effective

48
Q

What is the current application for controlled release local antibiotic delivery

A

treatment of localized recurrent periodontitis in cases that are otherwise stable

SP15 Periodontology (9 decks)

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