Antibiotics in periodontal therapy

Prepared by :

Wria s. rasheed

Outline:

Chemotherapeutic agentSystemic administration of antibioticsLocal administration of antibiotics

Chemotherapeutic agent :

is a general term for a chemical substance that provides a clinical therapeutic benefit .this term dose not specify in what way the agent aids in attaining a clinical benefit .clinical benefits can be derived through antimicrobial actions or an incrase in the host’s resistance . Can be administered locally and systemiclly .

Systemic administration of antibiotics TetracyclinesMetronidazolePenicillinsCephalosporinsClindamycinCiprofloxacinmacrolides

Tetracycline : Used widely in periodontal disease

treatment .Used frequently in treatment of refractory

periodontitis and LAP.Inhibit the growth of a.a (aggregatibacter

actinomycetemcomitans).Exert an anticollagenase effect that can

inhibit bone destruction and may aid bone regeneration.

Tetracycline:

Bacteriostatic Effective against rapidly multiplying bacteria .

G+ve>>G-ve bacteria Administration 250mg 4 times daily.

side effects:

GI disturbance photosensitivity increased blood urea nitrogen tooth discoloration when administered to

children up to 12 years .

Minocycline :

Effective against broad spectrum microorganisms,

Administered 200 mg/ day for 1 week

Less photosensitivity and renal toxicity than tetracycline

Doxycycline:

Has the same spectrum as minocycline but only given once daily .

metronidazole:Nitroimidazole compound developed for

protozoal infection Bactericidal to anaerobic organisms because

it disrupts the bacterial DNA Effective against p.g (porphyromonas

gingivalis) and p.i (provotela intermedia) but not drug of choice against A.A unless combined to other antibiotics .

Clinical uses :

1. Gingivitis 2. Necrotizing ulcerative gingivitis 3. Chronic periodontitis4. Aggressive periodontitis

Dosage:250mg 3 times daily for a week.

Side effect :1. Antabuse effect when alcohol in

ingested (severe cramp , nausea , vomiting )

2. Inhibit warfarin metabolism 3. Patient undergoing anti coagulant

therapy should avoid metranidazole because it prolongs prothrombin time .

4. Should be avoided in patient on lithium 5. metallic taste in mouth

Pencillins:Most widely used antibiotic.Inhibt bacterial cell wall production

so they are bactericidal .Side effect:induce allergic reactions

and bactrial resistance .

Clinical use

Pencillins other than amoxicillin and amoxicillin+clavulanate potassium (augmentin) have not been shown to increase periodontal attachment level and their use in periodontal therapy dose not appear to be justified .

Amoxicillin : used for treatment of aggressive periodontitis both localized and generalized forms.

Augmentin: have resistance to penicillinase enzymes produced by bactria . Used for treatment of refractory periodontitis .

Clindamycin:Effective against anaeribic bacteria Can be used when the patient have

allergy to penicillin . side effect : associated with

pseudomembranous colitis .

Ciprofloxacin:Active against gram negative rods

all facultative and some anaerobic putative periodontal pathogens

Only antibiotics in periodontal health to which all strains of A.A are susceptible ,.

Side effect : metallic taste , inhibit metabolism of theophilline and caffeine , enhance the effect of warfarin and other anticoagulants.

Macrolids:Inhibit protein synthesis , bacteriostatic or

bactericidal depending on drug concentration .

Macrolids used in periodontal treatment that includes erythromycin , spiramycin and azithromycin.

Spiramycin is excreted in high concentration in saliva but erythromycin is not concentrated in GCF , so it is not effevtive against most putative periodontal pathogens.

Serial and combination antibiotic therapy:

Periodontitis is a mixed infection , in this condition treatment requires more than one antibiotic serially or in combination.

1. Amoxicillin + clavulanate potassium (augmentin) (resistance to penicillinase enzymes produced by some bacteria )

2. Metronidazole + augmentin : provide excellent elimination of many organisms in adult and LAP.

3. Metronidazole+ spiramycin (rodogyl) :effective against oral infection , dental absces gingivitis , stomatitis , periodontitis .

Local delivery of antibioticSmaller total dosages of topical agents can be delivered inside the pocket avoiding the side effect of systemic antibacterial agensts while increasing the exposure of the target microorganisms to higher concentration .

Local delivery agents:

1. Tetracycline containing fiber 2. Subgingival doxycycline 3. Subgingival minocycline 4. subgingival metronidazole5. Subgingival chlorhexidine