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CSA Antimicrobials, local ant. in heart folder > systemic antimicrobials in perio. > Flashcards

systemic antimicrobials in perio. Flashcards

1
Q

what is antimicrobials used alongside ?

A

mechanical therapy

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2
Q

What can antimicrobials do to biofilms?

A

incrase min. inhibitory conc.

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3
Q

what does chronic perio. severity correlate with ?

A

Oral hygiene

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4
Q

Why dont we just ONLY prescribe antimicrobials for periodontitis?

A 
Antimicrobial resistance
risk from MRSA 
allergic reactions
Fungal overgrowth 
cost
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5
Q

What is chlorhexidine?

A

strong antimicrobial

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6
Q

What is conventional therapy?

A

sticking to treatment without need of antimicrobials

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7
Q

Problem with conventional therapy?

A 
Cost - patient and NHS
Pain - use LA
Time - multi appts.
Instrumentation
Skill
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8
Q

Why use Antimicrobials?

A

may not respond to scaling (NST)
Agress. Perio may have specific microbial aetiology
Bacterial reinvasion

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9
Q

What is Periostat?

A

low dose of doxycycline 20mg twice a day

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10
Q

what can periostat reduce?

A

bystander damage, damage caused to healthy host tissue

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11
Q

How can Porphyromonas gingivalis be passed?

A

can be between spouses

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12
Q

2 types of chronic and aggressive periodontitis ?

A

localised or generalised

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13
Q

Types of perio. disease?

A

Agressive
Chronic
NUG

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14
Q

Symptoms of aggressive periodontitis ?

A

red gingival inflammation

bone loss

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15
Q

Indications for use of antibiotics?

A

NUG
perio. abscesses with no drainage
to reduce risk of post op infection after perio surgery

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16
Q

What to question when you see a perio. abscess?

A

is tooth vital?
can be drained?
systemic effects?
can occlusal force be reduced?

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17
Q

WHAT is NUG?

A

fuso-spirochete infection invading SOFT tissue

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18
Q

what does NUG cause?

A
  • soft tissue necrosis

- loss of gingival contour which leads to chronic periodontal pocketing

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19
Q

Microbiology of non specific periodontitis?

A

bacteria in large quantities left long enough

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20
Q

microbiology of specific periodontitis ?

A

colonies of P.Gingivalis seen in aggressive perio. and high levels of antibodies formed

21
Q

What is ecological microbiology ?

A

good bacteria thrive and stop harmful bac. growing

22
Q

what are indicators for systemic antimicrobials?

A

NUG
Perio. abscess
Agressive perio

23
Q

What treatment planning is there for periodontitis?

A
  • NST ( Scaling & rsd)
  • Monitor response
  • if all fails then surgical therapy
24
Q

What does NST do?

A
  • decrease bacterial load

- may produce resolution

25
Q

How do you monitor response after 6 weeks?

A
  • see IF PPD reduced and no BOP

- if still active, repeat NST with decontamination protocol

26
Q

what is decontamination protocol?

A
  • scaling over 2 visits in same week
  • THEN OHI and chlorhexidine
  • antibiotics start on day 1 of decontamination
27
Q

do you ever have a surface free of all necrotic cementum and calculus?

A

NEVER! just enough to allow for healing

28
Q

why do we do systemic therapy?

A
  • aggressive perio- affects whole mouth and sites re infect

- drugs concentrated within GCS and targers pocket flora

29
Q

what factors affect eficacy?

A
  • binding of drug to tissue
    • Protection of key organisms by non-target organisms binding or consuming drug
    • Bacterial tissue invasion
    • Total bacterial load
    • Previous drug therapy – patients will be resistant to therapy if always have systemic antimicrobials
    • Non-pocket infected sites – just become re infected
30
Q

what can some bacteria produce?

A

beta lactamase that inactivates beta lactam drugs like penicillin

31
Q

what beta lactamase inhibitor is used with amoxicillin sometimes?

A

Clavulanic acid- prevent bacteria making beta lactamase

32
Q

what do antibacterial drugs inhibit?

A
  • cell wall synthesis
  • protein synthesis
  • bacterial cell metabolism
  • they interfere with bacterial nucleic acid synthesis
33
Q

What is microbial testing?

A

-culture using PCR/ELISA/CHeck hybridisation

34
Q

why do we microbial test?

A

to see of perio. is chronic or aggressive

- identifies specific bacteria

35
Q

what does tetracycline do?

A
  • Good because of their antibacterial effect
  • Concentrated in GCF
  • Binds to root surface
  • Released slowly
  • Fibroblast stimulation
  • Osseous induction
  • Anticollagenase (inhibits matrix metalloproteinases)
36
Q

what are current regimes adjunctive to mechanical therapy in LDI?

A
  • Tetracycline’s – 250mg – 4 times a day – 14 days
  • Doxycycline 100mg – twice a day for 1st day, once a day for 13 days
  • Amoxicillin 250 mg with metronidazole 200 mg – 2 a day for 7 days
37
Q

When to use Amoxocillin?

A

500 mg, 2-3 times for 8 days it’s Bacteriocidal for

Gram + and Gram –

38
Q

what is bacteriostatic?

A

agent prevents the growth of bacteria

39
Q

What is bactericidal?

A

KILLS BACTERIA

40
Q

when to use tetracycline?

A

500 mg, 4 times for 21 days its bacteriostatic (Gram+ > Gram –)

41
Q

When to use Minocycline?

A

100-200 mg, 1 time for 21 days Bacteriostatic (Gram+ > Gram –)

42
Q

When to use doxycycline?

A

100-200 mg, 1 time for 21 days Bacteriostatic (Gram+ > Gram –)

43
Q

when to use ciprofloxacin?

A

500 mg, 2 times for 8 days Bacteriocidal (Gram – rods)

44
Q

When to use Azithromycin?

A

500mg 1 time 4-7 days Bactericidal or bacteriostatic

depending upon the dose, broad spectrum

45
Q

when to use Clindamycin?

A

300mg 2 times for 5-6 days Bactericidal

46
Q

When to use Metronidazole?

A

500mg 2 times for 8 days Bactericidal to Gram-

47
Q

reasons for failure of antimicrobial therapy?

A
  • Lack of culture and sensitivity
  • Failure to achieve drainage
  • Non-bacterial causative agent (viral)
  • Incorrect drug use
  • Lack of compliance
  • Defective host response – AIDs patient
  • risk factors e.g. smoking
  • Lack of substantivity of local agents
  • Drug resistance
  • Diabetes
48
Q

What does diabetes do to a patient with perio disease?

A

chance of managing it is redcued

49
Q

What is exogenous infecting agents for perio?

A

•A. actinomycetemcomitans and P. gingivalis

CSA Antimicrobials, local ant. in heart folder (2 decks)

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