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This document discusses the use of antibiotics, both systemic and local, in the treatment of periodontal disease. It outlines several antibiotics commonly used systemically, including tetracyclines, metronidazole, penicillins, cephalosporins, clindamycin, ciprofloxacin, and macrolides. It notes their mechanisms of action, effectiveness against various bacteria, recommended dosages, and potential side effects. The document also discusses using antibiotics in combination or sequentially, as periodontal infections often involve multiple bacteria. Finally, it mentions the benefits of local antibiotic delivery directly into periodontal pockets to treat target bacteria while avoiding systemic side effects.
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- 1. Antibiotics in periodontal therapy Prepared by : Wria s. rasheed
- 2. Outline: Chemotherapeutic agent Systemic administration of antibiotics Local administration of antibiotics
- 3. 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 .
- 4. Systemic administration of antibiotics Tetracyclines Metronidazole Penicillins Cephalosporins Clindamycin Ciprofloxacin macrolides
- 5. 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.
- 6. Tetracycline: Bacteriostatic Effective against rapidly multiplying bacteria . G+ve>>G-ve bacteria Administration 250mg 4 times daily.
- 7. side effects: GI disturbance photosensitivity increased blood urea nitrogen tooth discoloration when administered to children up to 12 years .
- 8. Minocycline : Effective against broad spectrum microorganisms, Administered 200 mg/ day for 1 week Less photosensitivity and renal toxicity than tetracycline
- 9. Doxycycline: Has the same spectrum as minocycline but only given once daily .
- 10. 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 .
- 11. Clinical uses : 1. Gingivitis 2. Necrotizing ulcerative gingivitis 3. Chronic periodontitis 4. Aggressive periodontitis Dosage: 250mg 3 times daily for a week.
- 12. 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
- 13. Pencillins: Most widely used antibiotic. Inhibt bacterial cell wall production so they are bactericidal . Side effect:induce allergic reactions and bactrial resistance .
- 14. 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 .
- 15. 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 .
- 16. Clindamycin: Effective against anaeribic bacteria Can be used when the patient have allergy to penicillin . side effect : associated with pseudomembranous colitis .
- 17. 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.
- 18. 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.
- 19. 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 .
- 20. Local delivery of antibiotic Smaller 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 .
- 21. Local delivery agents: 1. Tetracycline containing fiber 2. Subgingival doxycycline 3. Subgingival minocycline 4. subgingival metronidazole 5. Subgingival chlorhexidine