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
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
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
4
Q
what are the components of a bacterial cell
A
capsule cell wall cytoplasmic membrane flagella fimbriae ribosomes nucleoid RER DNA
5
Q
what is the nature of perio infections
A
polymicrobial
6
Q
which is the most accepted plaque hypothesis
A
ecological
7
Q
what are the plaque hypothesis
A
non specific
specific
ecological
8
Q
what are the classifications of antimicrobials
A
based on spectrum of activity
based on the action
9
Q
what are antimicrobials based on the spectrum of activity called
A
narrow spectrum
broad spectrum
10
Q
what are antimicrobials based on the action
A
bacteriostatic
bactericidal
11
Q
what would we prefer to give patients
A
narrow spectrum
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
13
Q
what is bacteriostatic
A
STOPS OR INHIBITS THE MULTIPLICATION OF THE BACTERIA
14
Q
what is bactericidal
A
kills the bacteria
15
Q
what do we prefer to give bacteriostatic or bactericidal
A
bactericidal
16
Q
why do we not give bacteriostatic
A
takes longer
patient compliance
17
Q
what is the mode of action for systemic antibiotics
A
- inhibition of cell wall synthesis
- inhibition of cytoplasmic membrane function
- inhibition of nucleic acid synthesis
- inhibition of ribosome function therefore protein synthesis
- inhibition of folate metabolism
18
Q
what does amoxicillin inhibit
A
cell wall synthesis
19
Q
what does metronidazole inhibit
A
nucleic acid synthesis by breaking down DNA
20
Q
WHAT DOES TETRACYCLINE AND MACROLIDES inhibit
A
protein or ribosome synthesis
21
Q
disadvantages of antimicrobials
A
hypersensitivity GI disturbances alterations in the commensal flora drug interactions- eg alcohol and disulfiram bacterial interactions
22
Q
what happens if alcohol and disulfiram are mixed
A
it can have a potential anticoagulant effect
and avoid during pregnancy
23
Q
what diseases can occur due to alterations in the commensal flora
A
pseudomembranous colitis
oral candidiasis
24
Q
what drug can cause staining of the teeth
A
tetracycline- causes yellow bands in teeth therefore avoid during pregnancy
25
how may people died per year in the EU due to multiple resistant drug bacteria
25000
26
how much do we spend each year in extra healthcare and loss of productivity
1.9 billion
27
what is the antimicrobial stewardship programme
an organisational or healthcare system wide approach to promote the monitoring of use of anti microbial to preserve effectiveness
28
what are antimicrobial stewardship strategies
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
29
when is european antibiotic world awareness day
18th november
30
when is world antibiotic awareness week
12-18th week
31
what should we let patients know in regards to antibiotics
to take them as they are meant to be used
| and to not demand antibiotics
32
what can happen to bacteria when patients use chlorhexidine
a gene is activated in Acinetobacter Baumannii to mediate chlorhexidine by actively transporting CHX out of the cell
33
where is acinetobacter baumannii seen
in afghanistan and iraqi war soldiers
34
which bacteria can chlorhexidine effect
acinetobacter baumannii - new super bug risk
35
what is the risk of acinetobacter baumannii
new super bug risk
36
what re the factors that affect efficacy
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
37
what is beta lactamase
an enzyme- which can inactivate beta lactam drugs such as penicillin
38
how many times of beta lactamase are there
more than 100 types
39
what is a beta lactamase inhibitor
calvulanic acid also can be used with amoxicillan - Co-amoxiclav
40
what re the 8 types of classification of antibiotics
1. beta lactams
2. aminoglycosides
3. sulphonamides
4. tetracyclines
5. azaleas
6. quinolones
7. macrolides
8. other
41
eg of beta lactams
penicillins
42
eg of aminoglycosides
gentamycin
43
eg of sulphonamides
sulfa/sulpha group
44
eg of tetracycline
doxycycline, minocycline
45
eg of quinolones
ciprofloxacin
46
eg of macrolides
erythromycin and azithromycin
47
why might antimicrobial therapy fail
```
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
```
48
what is lack of culture and sensitivity
swab taken and the sample is cultured and then we can see what and which conc of antibiotic is most effective
49
why can we do not culture and sensitivity all the time
it is very expensive and not feasible
50
what is substantivity
the drug needs to bind to the tissues and release over a period of time
51
how do we prescribe antibiotic
EMPIRICAL
culture and sensitivity- ideal but not always possible
mono/combination therapy
52
what ideal investigations could we carry out
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
53
why is PCR and ELISA not the best
only tells what type of bacteria are present
54
why is culture and sensitivity the best
tells us which bacteria are present AND what concentration and types of drug they are sensitive to
55
. Which of the following is NOT a
mechanism of action of antibacterial drugs?
1.Breaking of bacterial DNA strands
2.Inhibition of cell wall synthesis
3.Inhibition of capsular material formation
4.Inhibition of protein synthesis
3.Inhibition of capsular material formation
56
does chronic periodontitis require antibiotics
no
57
does aggressive periodontitis require antibiotics
maybe
58
what systemic disease do we think of when talking about periodontitis
diabetes mellitus
59
do we give anitbitioics in NG/NP
no
60
does periodontitis as manifestation of systemic disease require antibiotics
maybe
61
does abscess of periodontium require antibiotics
maybe ut after diabetes in control and RSD
62
does periodontitis associated with Endodontics lesions require antibiotics
no
63
how do we know infection has spread
fever
swelling
rest issues
64
what is the rationale for systemic therapy
```
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
```
65
what antibiotics can be we use for stage 3/4 grade b or c
Penicillins (amoxicillin) with or without clavulanic acid
Tetracyclines (doxycycline, tetracycline)
Macrolides (azithromycin) and
Nitroimidazole (metronidazole)
66
what is the dosage and duration for amoxicillin mechanical perio therapy
500 mg, 2-3 times for 8 days Bacteriocidal
| Gram + and Gram –
67
what is the dosage and duration for amoxicillin and clavulanic acid mechanical perio therapy
500 mg, 2-3 times for 8 days Bacteriocidal (broader spectrum than amoxicillin alone)
68
what is the dosage and duration for tetracycline mechanical perio therapy
Tetracycline 500 mg, 4 times for 21 days Bacteriostatic (Gram+ > Gram –)
69
what is the dosage and duration for minocycline mechanical perio therapy
100-200 mg, 1 time for 21 days Bacteriostatic (Gram+ > Gram –)
side effects: Bacterial resistance to minocycline
70
what is the dosage and duration for doxycycline mechanical perio therapy
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
71
what is the side effect of amoxicillin
Penicillinase sensitive
72
what is the side effect of amoxicillan and clavulanic acid
side effects: Diarrhoea, colitis, nausea
73
what is the side effect of tetracycline
side effetcs: Severe sunburn if exposure to bright sunshine, severe stomach pain and nausea
74
what is the side effect of minocycline
side effects: Bacterial resistance to minocycline
75
what is the side effect of doxycycline
side effects Nausea, gastrointestinal discomfort
76
how many times a day to patients need to take azithromycin
500 mg 3 days 1x a day
bactericidal or bacteriostatic depending upon the dose
broad spectrum
77
what is the side effect of azithromycin
diarrhoea
vomiting
discomfort
78
what is the dosage and duration for clindamycin
300mg
2x a day
for 5-6 days
bactericidal anaerobic bacteria
79
why do we not give clindamycin
do not give in dental setting as it causes pseudomembranous colitis far more dangerous than clearing a bacterial infection
80
what is the duration and dosage of metronidazole
500mg 2 times for 8 days Bactericidal to Gram- (Porphyromonas gingivalis and Prevotella intermedia)
ineffective for A.actinomycetemcomitans
81
what are the side effects of metronidazole
dizzy
blurred
headaches
82
why do we need to be cautious prior to prescription of antibiotics for treatment of perio diease
The antibiotic resistance associated with aggressive periodontitis in 50 UK patients
microbial testing SHOULD BE carried out but not routinely done
83
what are the benefits of microbial testing
May assist chronic VS aggressive periodontitis diagnosis
Identify specific bacteria for selection of antibiotic adjuncts
Performed as part of part of risk assessment
84
what bacteria causes necrotising perio disease
fusospirochaetal complex
| eg spirochetes and fusiform bacteria
85
where are the bacteria found in large numbers in NPD
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.
86
what is the management of NDP in the acute phase treatment
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
87
what questions do we need to consider when looking managing a perio abscess
Is it vital?
Can drainage be established ?
Are there systemic effects? – YES, SYSTEMIC ANTIBIOTICS
Can the occlusal force be reduced?
