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CSA SR > systemic antimicrobials and perio disease part 1 > Flashcards

systemic antimicrobials and perio disease part 1 Flashcards

to discuss the rationale for adjunctive antimicrobial therapy in perio disease

1
Q

what are antibiotics against

A

specifically against bacteria

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2
Q

definition of antibiotics

A

drugs that kill or halt the multiplication of bacterial cells at concentrations that are relatively harmless to host tissues and therefore can be used to treat infections caused by bacteria

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3
Q

what is an infection

A

invasion of micro-organisms in the host cell and the reaction of the host to it- manifests in many forms

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4
Q

what are the components of a bacterial cell

A 
capsule 
cell wall 
cytoplasmic membrane 
flagella 
fimbriae 
ribosomes 
nucleoid 
RER 
DNA
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5
Q

what is the nature of perio infections

A

polymicrobial

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6
Q

which is the most accepted plaque hypothesis

A

ecological

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7
Q

what are the plaque hypothesis

A

non specific
specific
ecological

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8
Q

what are the classifications of antimicrobials

A

based on spectrum of activity

based on the action

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9
Q

what are antimicrobials based on the spectrum of activity called

A

narrow spectrum

broad spectrum

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10
Q

what are antimicrobials based on the action

A

bacteriostatic

bactericidal

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11
Q

what would we prefer to give patients

A

narrow spectrum

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12
Q

why do we not want to give broad spectrum antibiotics all the time

A

so we do not have any side effects eg antibiotic resistance

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13
Q

what is bacteriostatic

A

STOPS OR INHIBITS THE MULTIPLICATION OF THE BACTERIA

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14
Q

what is bactericidal

A

kills the bacteria

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15
Q

what do we prefer to give bacteriostatic or bactericidal

A

bactericidal

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16
Q

why do we not give bacteriostatic

A

takes longer

patient compliance

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17
Q

what is the mode of action for systemic antibiotics

A
  1. inhibition of cell wall synthesis
  2. inhibition of cytoplasmic membrane function
  3. inhibition of nucleic acid synthesis
  4. inhibition of ribosome function therefore protein synthesis
  5. inhibition of folate metabolism
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18
Q

what does amoxicillin inhibit

A

cell wall synthesis

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19
Q

what does metronidazole inhibit

A

nucleic acid synthesis by breaking down DNA

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20
Q

WHAT DOES TETRACYCLINE AND MACROLIDES inhibit

A

protein or ribosome synthesis

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21
Q

disadvantages of antimicrobials

A 
hypersensitivity 
GI disturbances 
alterations in the commensal flora 
drug interactions- eg alcohol and disulfiram 
bacterial interactions
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22
Q

what happens if alcohol and disulfiram are mixed

A

it can have a potential anticoagulant effect

and avoid during pregnancy

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23
Q

what diseases can occur due to alterations in the commensal flora

A

pseudomembranous colitis

oral candidiasis

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24
Q

what drug can cause staining of the teeth

A

tetracycline- causes yellow bands in teeth therefore avoid during pregnancy

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25
Q

what is the antimicrobial stewardship programme

A

an organisational or healthcare system wide approach to promote the monitoring of use of anti microbial to preserve effectiveness

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26
Q

what are antimicrobial stewardship strategies

A

evidence based for optimal standards for routine antimicrobial prescribing
ensuring competency and education for prescribers
communication to all stakeholders
auditing the impact and uptake of processes
optimising outcome for patients prescribed antimicrobials

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27
Q

what should we let patients know in regards to antibiotics

A

to take them as they are meant to be used

and to not demand antibiotics

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28
Q

what can happen to bacteria when patients use chlorhexidine

A

a gene is activated in Acinetobacter Baumannii to mediate chlorhexidine by actively transporting CHX out of the cell

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29
Q

where is acinetobacter baumannii seen

A

in afghanistan and iraqi war soldiers

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30
Q

which bacteria can chlorhexidine effect

A

acinetobacter baumannii - new super bug risk

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31
Q

what is the risk of acinetobacter baumannii

A

new super bug risk

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32
Q

what re the factors that affect efficacy

A

binding of drug to tissue
protraction of key organisms by non target organisms binding or consuming the drug
bacterial tissue invasion- must disrupt the biofilm to get access to the key pathogens- as strong cross links are made between key pathogens
total bacterial load
previous drug therapy
non pocket infected sites

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33
Q

what is beta lactamase

A

an enzyme- which can inactivate beta lactam drugs such as penicillin

34
Q

how many times of beta lactamase are there

A

more than 100 types

35
Q

what is a beta lactamase inhibitor

A

calvulanic acid also can be used with amoxicillan - Co-amoxiclav

36
Q

what re the 8 types of classification of antibiotics

A
  1. beta lactams
  2. aminoglycosides
  3. sulphonamides
  4. tetracyclines
  5. azaleas
  6. quinolones
  7. macrolides
  8. other
37
Q

eg of beta lactams

A

penicillins

38
Q

eg of aminoglycosides

A

gentamycin

39
Q

eg of sulphonamides

A

sulfa/sulpha group

40
Q

eg of tetracycline

A

doxycycline, minocycline

41
Q

eg of quinolones

A

ciprofloxacin

42
Q

eg of macrolides

A

erythromycin and azithromycin

43
Q

why might antimicrobial therapy fail

A 
Lack of culture and sensitivity 
Failure to achieve drainage 
Non-bacterial causative agent- eg if viral or parasitic will not work  
Incorrect drug duration or dose- not adequate to achieve plasma conc  
Lack of compliance
Defective host response 
Persistent risk factors e.g. smoking
Lack of substantivity of local agents 
Drug resistance
44
Q

what is lack of culture and sensitivity

A

swab taken and the sample is cultured and then we can see what and which conc of antibiotic is most effective

45
Q

why can we do not culture and sensitivity all the time

A

it is very expensive and not feasible

46
Q

what is substantivity

A

the drug needs to bind to the tissues and release over a period of time

47
Q

how do we prescribe antibiotic

A

EMPIRICAL
culture and sensitivity- ideal but not always possible
mono/combination therapy

48
Q

what ideal investigations could we carry out

A

Culture and sensitivity- the best
PCR- only tells what type of bacteria are present
ELISA
Checkerboard hybridization
DNA analysis via nucleic acid probes
Genome tests
BANA test trypsin like enzyme chairside 1990s invalidated

49
Q

why is PCR and ELISA not the best

A

only tells what type of bacteria are present

50
Q

why is culture and sensitivity the best

A

tells us which bacteria are present AND what concentration and types of drug they are sensitive to

51
Q

does chronic periodontitis require antibiotics

A

no

52
Q

does aggressive periodontitis require antibiotics

A

maybe

53
Q

what systemic disease do we think of when talking about periodontitis

A

diabetes mellitus

54
Q

do we give anitbitioics in NG/NP

A

no

55
Q

does periodontitis as manifestation of systemic disease require antibiotics

A

maybe

56
Q

does abscess of periodontium require antibiotics

A

maybe ut after diabetes in control and RSD

57
Q

does periodontitis associated with Endodontics lesions require antibiotics

A

no

58
Q

how do we know infection has spread

A

fever
swelling
rest issues

59
Q

what is the rationale for systemic therapy

A 
Panoral infection in (aggressive) periodontitis
 Other oral niches colonised with periodontal pathogens
 Drugs are concentrated in GCF
 Maintains MIC (minimal inhibitory concentration) for long duration
60
Q

what antibiotics can be we use for stage 3/4 grade b or c

A

Penicillins (amoxicillin) with or without clavulanic acid
Tetracyclines (doxycycline, tetracycline)
Macrolides (azithromycin) and
Nitroimidazole (metronidazole)

61
Q

what is the dosage and duration for amoxicillin mechanical perio therapy

A

500 mg, 2-3 times for 8 days Bacteriocidal

Gram + and Gram –

62
Q

what is the dosage and duration for amoxicillin and clavulanic acid mechanical perio therapy

A

500 mg, 2-3 times for 8 days Bacteriocidal (broader spectrum than amoxicillin alone)

63
Q

what is the dosage and duration for tetracycline mechanical perio therapy

A

Tetracycline 500 mg, 4 times for 21 days Bacteriostatic (Gram+ > Gram –)

64
Q

what is the dosage and duration for minocycline mechanical perio therapy

A

100-200 mg, 1 time for 21 days Bacteriostatic (Gram+ > Gram –)
side effects: Bacterial resistance to minocycline

65
Q

what is the dosage and duration for doxycycline mechanical perio therapy

what is the dosage and duration for ciprofloxacin mechanical perio therapy

A

100-200 mg, 1 time for 21 days Bacteriostatic (Gram+ > Gram –)
Ciprofloxacin 500 mg, 2 times for 8 days Bacteriocidal (Gram – rods)
side effects Nausea, gastrointestinal discomfort

66
Q

what is the side effect of amoxicillin

A

Penicillinase sensitive

67
Q

what is the side effect of amoxicillan and clavulanic acid

A

side effects: Diarrhoea, colitis, nausea

68
Q

what is the side effect of tetracycline

A

side effetcs: Severe sunburn if exposure to bright sunshine, severe stomach pain and nausea

69
Q

what is the side effect of minocycline

A

side effects: Bacterial resistance to minocycline

70
Q

what is the side effect of doxycycline

A

side effects Nausea, gastrointestinal discomfort

71
Q

how many times a day to patients need to take azithromycin

A

500 mg 3 days 1x a day
bactericidal or bacteriostatic depending upon the dose
broad spectrum

72
Q

what is the side effect of azithromycin

A

diarrhoea
vomiting
discomfort

73
Q

what is the dosage and duration for clindamycin

A

300mg
2x a day
for 5-6 days
bactericidal anaerobic bacteria

74
Q

why do we not give clindamycin

A

do not give in dental setting as it causes pseudomembranous colitis far more dangerous than clearing a bacterial infection

75
Q

what is the duration and dosage of metronidazole

A

500mg 2 times for 8 days Bactericidal to Gram- (Porphyromonas gingivalis and Prevotella intermedia)
ineffective for A.actinomycetemcomitans

76
Q

what are the side effects of metronidazole

A

dizzy
blurred
headaches

77
Q

why do we need to be cautious prior to prescription of antibiotics for treatment of perio diease

A

The antibiotic resistance associated with aggressive periodontitis in 50 UK patients
microbial testing SHOULD BE carried out but not routinely done

78
Q

what are the benefits of microbial testing

A

May assist chronic VS aggressive periodontitis diagnosis
Identify specific bacteria for selection of antibiotic adjuncts
Performed as part of part of risk assessment

79
Q

what bacteria causes necrotising perio disease

A

fusospirochaetal complex

eg spirochetes and fusiform bacteria

80
Q

where are the bacteria found in large numbers in NPD

A

in the slough and necrotic tissue at the surface of the ulcer and also invades greatest distance in the underlying intact tissue at the base of the ulcer.

81
Q

what is the management of NPD in the acute phase treatment

A

1.Removal of supra and sub gingival deposits
-ultrasonic scaling.
2. Systemic antibiotic –
Metronidazole tablets 200mg, three
times daily for 3 days
3. Chlorhexidine mouth rinse

82
Q

what questions do we need to consider when looking managing a perio abscess

A

Is it vital?
Can drainage be established ?
Are there systemic effects? – YES, SYSTEMIC ANTIBIOTICS
Can the occlusal force be reduced?

CSA SR (52 decks)

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