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2nd Yr- CSA- Systemic Antimicrobials in Periodontal Therapy > Systemic Antimicrobials in Periodontal Therapy 1 (NAIK) > Flashcards

Systemic Antimicrobials in Periodontal Therapy 1 (NAIK) Flashcards

1
Q

Outline the main differences between the 1999 and 2018 periodontal disease classification

A
  1. Gingival disease is now split into: gingival health, periodontal health and disease
  2. Chronic periostitis is now classified as periodontitis and put into stages 1-5 and grades A-C
  3. Peri implant disease and conditions have been added to the specification
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2
Q

What does it mean when a patient is said to have stage I periodontitis?

A

The periodontitis is in the initial stages

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3
Q

What does it mean when a patient is said to have stage II periodontitis?

A

The patient has moderate periodontitis

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4
Q

What does it mean when a patient is said to have stage III periodontitis?

A

The patient has severe periodontitis with potential for additional tooth loss

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5
Q

What does it mean when a patient is said to have stage IV periodontitis?

A

The patient has severe periodontitis with potential for loss of dentition

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6
Q

How is periodontitis classified according to the 2018 classifications

A
  1. Stage is determined (I-IV)
  2. Extent and distribution is evaluated
  3. A grade is given (A-C)
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7
Q

What is the stage at which periodontal disease is at based on?

A

It is based on severity and complexity of management

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8
Q

How is the extent and distribution of periodontal disease describes?

A

AS local or generalised

The Molar-Incisor distribution is also considered

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9
Q

What is the grade at which periodontal disease is at based on?

A

It is based on the evidence or risk of rapid progression

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10
Q

What does it mean when a patient is said to have Grade A periodontitis?

A

The periodontitis is progressing slowly

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11
Q

What does it mean when a patient is said to have Grade B periodontitis?

A

The periodontitis is progressing at a moderate rate

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12
Q

What does it mean when a patient is said to have Grade C periodontitis?

A

The periodontitis is progressing rapidly

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13
Q

What is an infection?

A

When microorganism invade a host and the host reaction to this invasion

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14
Q

What are 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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15
Q

What is the nature of periodontal infections?

A

It is polymicrobial

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16
Q

Name the 3 different plaque hypotheses

A
  1. Non specific
  2. Specific
  3. Ecological
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17
Q

Which plaque hypothesis is the most accepted?

A

The ecological plaque hypothesis

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18
Q

How can antibiotics be classified?

A
  1. Based on their chemical structures
  2. Based on their spectrum of activity
  3. Based on their action
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19
Q

Name some of the groups that antibiotics fall under when they are classified by their chemical structures

A
  1. Beta-lactams
  2. Aminoglycosides
  3. Sulphonamides
  4. Tetracyclines
  5. Azoles
  6. Quinolones
  7. Macrolides
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20
Q

Give examples of antibiotics with a beta lactam structure

A

Penicillin

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21
Q

Give examples of antibiotics with a amino glycoside structure

A

Gentamycin

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22
Q

Give examples of antibiotics with an azole structure

A

Metronidazole

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23
Q

Give examples of antibiotics with a quinolone structure

A

Ciprofloxacin

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24
Q

Give examples of antibiotics with a macrolide structure

A

Erythromycin, Azithromycin

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25
Q

How do we describe an antibiotics spectrum of activity

A
  1. Narrow spectrum

2, Broad spectrum

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26
Q

What does it mean if an antibiotic has a broad spectrum

A

It affects all (or a lot of) bacterial species

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27
Q

What does it mean if an antibiotic has a narrow spectrum

A

It only targets certain types of antibiotics

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28
Q

When choosing an antibiotic do we prefer one with a broad or narrow spectrum of activity? why?

A

Narrow as we don’t want any side effects that may harm the patient
Also we want to minimise the chances of drug resistance bacteria forming

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29
Q

How do we describe the action of antibiotics

A
  1. Bacteriostatic

2. Bactericidal

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30
Q

What does it mean if a bacteria is bacteriostatic?

A

It stops/ inhibit the multiplication of Bactria

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31
Q

What does it mean if a bacteria is bactericidal?

A

It kills the bacteria

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32
Q

When choosing an antibiotic do we prefer one with that is bacteriostatic or bactericidal? why?

A

Bactericidal as they work quicker and so patient compliance is higher

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33
Q

List the difference mode of actions of systemic antibiotics

A
  1. Inhibits cell wall synthesis
  2. Inhibits cytoplasmic membran function
  3. Inhibits nucleic acid synthesis
  4. Inhibits ribosomal function and hence protein synthesis
  5. Inhibits folate metabolism
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34
Q

What does systemic mean?

A

For the whole body it is not specific to one particular site of the host

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35
Q

What is the mode of action of Amoxycillin?

A

They inhibit cell was synthesis

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36
Q

what is the mode of action of metronidazole

A

Inhibits nucleic acid synthesis by breaking down strands of DNA

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37
Q

what is the mode of action of tetracyclines and macrolides

A

Inhibits protein (ribosomal) synthesis

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38
Q

Which type of antibiotics do we commonly prescribed for dental infections

A

Metronidazole and amoxycillin

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39
Q

What are some of the disadvantages of the use of antibiotics

A
  1. Hypersensitivity
  2. Gastrointestinal disturbances
  3. Alterations in the commensal flora
  4. Drug interactions with alcohol
  5. Bacterial resistance
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40
Q

What is AMR?

A

Antimicrobial resistance

41
Q

How many deaths per year in the EU are due to multiple drug resistance bacteria

A

25,000

42
Q

Which antibiotic do we avoid in pregnancy?

A

Tetracycline

43
Q

What does the antibiotic Guardian teach?

A
  1. Don’t demand antibiotics
  2. Take antibiotics as they are prescribed to use
  3. Spread the work among friends and relatives
44
Q

What does antimicrobial stewardship teach?

A
  1. Evidence based optimal standards for routine antimicrobial prescribing
  2. Ensuring competency and education for prescribers
  3. Communication of issue to all stakeholders
  4. Auditing the impact and uptake of processes above
  5. Optimizing outcome for patients prescribed antimicrobials
45
Q

What is efficacy?

A

The ability of an antibiotic to produce a desired or intended result

46
Q

Give some factors that affect the efficacy of antibiotics

A
  1. How well the antibiotic can bind to tissue
  2. Protection of key organisms by non target organisms binding or consuming drugs
  3. Bacterial tissue invasions
  4. How extensive the total bacterial load is
  5. Previous drug therapy
  6. Non pocket infected sites
  7. Choice of drug
  8. Presence of a biofilm
  9. Beta-lactamasee production can stop beta lactic drugs
47
Q

what is Beta-lactamase?

A

An enzyme which can inactivate beta-lactam drugs

48
Q

Give an example of a Beta-lactamase inhibitor

A

Clavulanic acid

49
Q

Why might antimicrobial therapy fail

A 
1. Lack of bacterial culture and sensitivity 
2, Failure to achieve drainage 
3. Non bacterial causative agent eg viral or fungal infective 
4. Incorrect drug duration or dose 
5. Defective host responsive 
6. Lack of compliance
7. Persistent risk factors like smoking 
8. Lack of substantivity of local agents
9. Drug resistance
50
Q

What is culture ad sensitivity when we talk about antimicrobial therapy?

A

When we take a sample from the patient and grow the bacterial they have in a lab
Then we test several types of antibiotics on that culture to see which one is the most effective

51
Q

What is subsubstantivity

A

The ability of a drug to bind to tissues and please over a period of time

52
Q

How do we prescribe antibiotics?

A
  1. Empirically (ie we prescribe the drug we think will most likely target the bacterial infection)
  2. Do a culture and sensitivity to see exactly which drug is most effective
53
Q

What is the ideal way to prescribe antibiotics?

Why can’t we do this in every case?

A

Doing a culture and sensitivity test

But this is a lengthy and expensive process that is only done when all other antibiotics fail

54
Q

What is chronic periodontitis?

A

A patient that has an abundance of deposits of plaque

55
Q

How do we treat early periodontitis?

A

Scaling and root surface debridement + OHI

56
Q

Do we need to prescribe antibiotics for chronic periodontitis?

A

NO

57
Q

What is aggressive periodontitis?

A

When there is an inconsistent match between the presence of local factors and the destruction of oral environment

58
Q

Which systemic diseases can lead to the manifestation of periodontitis?

A

Type II diabetes

59
Q

Do we need to prescribe antibiotics for aggressive periodontitis?

A

Maybe depending on the cause of periodontitis

60
Q

Do we need to prescribe antibiotics for periodontitis as a manifestation of systemic disease?

A

Depends on the systemic disease that can caused the manifestation BUT first we need to distrust the biofilm

61
Q

Do we need to prescribe antibiotics for necrotising periodontal disease?

A

YES

62
Q

Do we need to prescribe antibiotics for abscesses of periodontium?

A

Theres some evidence to suggest the benefit of prescribing antibiotics in this case but first you must remove the plaque retentive factors and control any other risk actors

63
Q

When must you prescribe antibiotics to a patient with periodontitis?

A

When there’s a systemic spread of the disease

64
Q

How can we tell if theres a systemic spread of periodontitis

A
  1. Swelling
  2. Fever
  3. Embarrassment of respiratory air way
65
Q

There is no role for the use of antimicrobials in isolation from m_______ t________

A

Mechanical therapy such as scaling and RSD

66
Q

In which stages and grades of periodontitis is the use of antibiotics not indicated?

A

Stage 3 or 4

Grade A or B

67
Q

Name some of the possible antibiotic regimens for aggressive periodontitis

A
  1. Amoxicillin
  2. Amoxicillin with clavulanic acid
  3. Tetracylines
  4. Minocycline
  5. Doxycycline
  6. Ciprofloxacin
  7. Azithrromycin
  8. Clindamycin
  9. Metronidazole
68
Q

Is Amoxicillin bactericidal or bacteriostatic and which bacteria does it target?

A

Bactericidal

Targets gram + and -

69
Q

Is Tetracycline bactericidal or bacteriostatic and which bacteria does it target?

A

Bacteriostatic

Targets gram + more than gram -

70
Q

Is minocycline bactericidal or bacteriostatic and which bacteria does it target?

A

Bacteriostatic

Targets gram + more than gram -

71
Q

Is doxycycline bactericidal or bacteriostatic and which bacteria does it target?

A

Bacteriostatic

Targets gram + more than gram -

72
Q

Is Ciprofloxacin bactericidal or bacteriostatic and which bacteria does it target?

A

Bactericidal

Targets gram - rods

73
Q

What are some of the side affects of Amoxicillin

A

Penicillinase sensitive

74
Q

What are some of the side affects of Tetracycline

A

Severe sunburn if exposure to bright sunlight

Severe stomach pain and nausea

75
Q

What are some of the side affects of Ciprofloxacin

A

Nausea and gastrointestinal discomfort

76
Q

What are some of the disadvantages of Minocycline

A

Bacterial resistance

77
Q

How is amoxicillin prescribed?

A

500mg 2-3 times a day for 8 days

78
Q

How is tetracycline prescribed?

A

500mg 4 times a day for 21 days

79
Q

How is minocycline prescribed?

A

100-200mg once a day for 21 days

80
Q

How is Doxycycline prescribed?

A

100-200mg once a day for 21 days

81
Q

How is Ciprofloxacin prescribed?

A

500mg 2 times a day for 8 days

82
Q

Is Clindamycin bactericidal or bacteriostatic and which bacteria does it target?

A

Bactericidal

Targets anaerobic bacteria

83
Q

Is Metronidazole bactericidal or bacteriostatic and which bacteria does it target?

A

Bactericidal

Targets gram -

84
Q

Is Azithromycin bactericidal or bacteriostatic and which bacteria does it target?

A

bOTH DEPENDING ON THE DOSE

85
Q

How is Azithromycin prescribed?

A

500mg once a day for 4-7 days

86
Q

How is Clindamycin prescribed?

A

300mg twice a day for 5-6 days

87
Q

How is Metronidazole prescribed?

A

500mg twice a day for 8 days

88
Q

What are some of the side affects of Azithromycin

A

Diarrhoea vomiting discomfort

89
Q

What are some of the side affects of Clindamycin

A

Diarrhea or colitis

90
Q

What are some of the side affects of Metronidazole

A

Dizzy blurred vision

Headaches ineffective for A.actinomycetemcomitans

91
Q

Go through the guideline for treatment of aggressive periodontitis

A
  1. Diagnosis
  2. OHE
  3. Do a full mouth supra and sub gingival debridement of pockets greater than 4mm
  4. Prescribe antibiotics on the FINSL day of debridement
  5. Review periodontal indices
92
Q

What are the potential benefits of microbial testing

A
  1. May assist in differentiating chronic and aggressive periodontitis
  2. Can help identify specific bacteria for selection of antibiotic adjuncts
  3. Performed as part of a risk assessment
93
Q

What does NUG stand for?

A

Necrostisin ulcerative gingivitis

94
Q

What is necrotising ulcerative gingivitis?

A

It is a mixed bacterial infection caused by a group of anaerobes (spirochaetes and fusiform bacteria )

95
Q

How do we manage Necrotizing periodontal disease?

A
  1. Remove supra and sub gingival deposits
  2. Prescribe systemic antibiotic (Metronidazole tablets 200mg, three
    times daily for 3 days)
  3. Prescribe a Chlorhexidine mouth wash
  4. Maintenance phase
96
Q

What questions must we ask ourself when we diagnose a patient with a periodontal abscess?

A
  1. Is it vital
  2. Can drainage be established
  3. Are there systemic effects (if yes then prescribe systemic antibiotics)
  4. Can the occlusal force be reduced
97
Q

When are systemic antibiotics indicated in periodontal therapy?

A
  1. Aggressive periodontitis, following the mechanical debridement
  2. Necrotising periodontal disease
  3. Acute periodontal abscesses with the evidence of systemic involvement or the spread of infection
  4. Multiple or recurrent periodontal abscesses in poorly controlled diabetes following thorough debridement
98
Q

What are some of the non antibacterial effects of tetracycline?

A
  1. Concentrated in the GCF
  2. Binds to the root surface
  3. Slow release
  4. Fibroblasts are stimulated
  5. Osseous induction
  6. Anticollagenase

2nd Yr- CSA- Systemic Antimicrobials in Periodontal Therapy (2 decks)

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