Antibiotics in periodontics__perio_

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Antibiotics in periodontics__perio_

  1. 1. DEPARTMENT OF PERIODONTCS ANTIBIOTICS IN PERIODONTCS 1
  2. 2. ANTIBIOTIC • Antibiotics , which are chemical substance originally produced by microorgnism,either retard the growth of microorganism or result in their death • Now some antibiotics are chemically synthesized or semi synthesized 2
  3. 3. An Ideal Antibiotcs Should be 1. Selective and effective against micro organism 2. Bactericidal more than bacteriostatics 3 Not ineffective as a result of bacterical resistance 4. Not be inactivated by enzyme, plasma, protein or by body fluid 5. Maintained for sufficient period in blood plasma 6. Have minimal adverse effect 3
  4. 4. Classification of Antibiotic • Based on chemical structure 1 sulfonamides- sulfadiazine, PAS 2 Quinolones - ciprofloxacin , Nalidixic acid 3 Tetracyclines – Doxycycline, Tetracycline 4 Aminoglycosides – Gentamycin, streptomycin 5 Macrolides – Erythromycin, Roxithromycin, Azithromycin 6 B lactam antibiotic- Penicillins Cephalosporacin 4
  5. 5. 7 Nitroimidazoles - Metronidazole, Tinidazole 8 Imidazoles derivatives- ketoconazole, 9 Polypeptides Antibiotic – Bacitracin Polymyxin -B 10 Nicotinic acid derivatives Isoniazid, Pyrazinamide 5
  6. 6. Common Antibiotic used in PERIODONTCS Tetracycline Metronidazole Amoxicillin Clindamycin Cephalosporin Ciprofloxin 6
  7. 7. Antibiotic Resistance • Microorganism are some time resistance or unaffected by an antibiotic • Resistance can be Natural, that present before contact with drug Acquired, that developed during exposure with drug • The development of acquired resistance is genetic, with change in DNA , and is inherited by subsequent generation 7
  8. 8. * Micro organism are resistance to particular drug frequently are resistance to other chemically related antimicrobial agent This is referred as Cross Resistance * In antibiotic resistance implies In activation of antibiotic by bacterial enzyme Development of alternate pathway of drug metabolism by bacteria Biochemical alternation in the bacteria that prevent the uptake or binding of the antibiotic 8
  9. 9. TETRACYCLINE • Widely used in treatment of periodontics • Broad spectrum antibiotics • Effective aganist remove > gram- ve • MOA - inhibiting protein synthesis in bacteria • Bacteriostatics, effective against rapidly multiplying bacteria 9
  10. 10. Tetracycline Effective in treating periodontal disease because 1. Their concentration in GCF is 2 to 10 times more than blood serum 2. Ability to concentrate in POCKET 3. Inhibit the growth of Actinobacillus actinomycetemcomitans 4. Have anti collagenase effect inhibiting tissue destruction 5. Increase bone regeneration 10
  11. 11. Classification of Tetracycline based on generation Group 1 Chlortetracycline oxy tetracycline Tetracycline Group 2 Demeclocycline Methacycline Lymecycline Group 3 Doxycycline Minocycline 11
  12. 12. Tetracyclines.......... INDICATION Dental condition 1. Localized aggressive periodontitis because effective against A. actinomycetemcomitans 2. other Aggressive periodontitis. 3. Refractory periodontitis. 12
  13. 13. Tetracyclines.......... • Other condition Mixed bacterial infection - in respiratory infection - in genital urinary infection - G I T infection Contra indication Pregnancy Feeding mother Liver disorder Kidney disorder 13
  14. 14. Tetracyclines......... Adverse Effect • Permanent discoloration of teeth in offspring due to administration of drug during last half of pregnancy Administration of drug in 1-st 6 years of life • Teratogenicty • Photosensitivity • GIT disorder Nausea, Vomiting, Diarrhea Epigastric distress 14 Drecress absortion of vitamin k
  15. 15. Tetracyclines....... • Lethal hepatic toxicity if tetracycline use in renal disorder • Fancony type syndrome if outdated tetracycline Use in in renal disorder Now tetracycline less use in dental & medical, replace by more effective other combination antibiotic 15
  16. 16. Tetracycline Staining 16
  17. 17. METRONIDAZOLE 1. It is effective against anaerobic bacteria & anaerobic parasite 2. Anaerobic bacteria both gram +ve & gram –ve 3. MOA – inhibiting the growth of bacteria I by inhibit the bacterial DNA synthesis 4. On set of action – 8 hours 5. Duration of action - 24-48 hours 17
  18. 18. METRONIDAZOLE ....... • More effective against obligate anaerobic gram – ve bacteria • DOSE Orally - 200- 400 mg tid For 7-10 day Available as Metrogyl 400 mg Flagyl 400 mg 18
  19. 19. METRONIDAZOLE ........ INDICATION 1. Gingivitis 2. ANUG 3. Chronic Periodontitis 4. Aggressive Periodontitis 5. In Refractory Periodontitis In combination with amoxicillin 6. After extraction 7. All mixed infection with anaerobic bacteria 8. In severe odontogenic infection with other antibiotic 19
  20. 20. METRONIDAZOLE .......... Contra indication 1. Patient having alcohol habit 2. Patient taking anticoagulant therapy B/C it prolonge the pro thrombin time 3. CNS disorder 4. Blood disorder 5. Cirrhosis of liver 6. Renal disorder 20
  21. 21. METRONIDAZOLE .......... Adverse Effect 1. Abdominal problem Severe cramp, Nausea, Vomiting, Diarrhea 2. Metallic taste in mouth 3. Headache disorder 4. Dry mouth Not use as mono therapy for treatment of periodontal disease 21
  22. 22. Penicillins • These are B lactam antibiotic Types Penicillin –G (Benzyl Penicillin ) acid labile destroyed by gastric acid Penicillin- V acid stable ( given orally ) Penicillinase resistance penicillin Methicillin , cloxicillin, Oxacillin Extended spectrum Penicillin amphicilin, amoxicillin, bacampicillin 22
  23. 23. AMOXICILLIN Amoxicillin is a semi synthetic antibiotic Known as Broad spectrum penicillin Effective against gram- ve bacteria MOA of action – Inhibit synthesis of bacterial cell wall • Onset of action - 1-2 hours • Duration of action - 8 hours • • • • 23
  24. 24. Amoxicillin ....... • It show excellent absorption after orally administration • It susceptible to penicillanase • (Beta lactamase) produced by bacteria • For Periodontal therapy Given combined with clavulanate Amoxicillin + Clavulanate = AUGMENTIN It is against the penicillanase 24
  25. 25. Amoxicillin ....... INDICATION 1 As prophylaxis therapy before any periodontal surgery 2 Amoxicillin + Metronidazole In localized juvenile periodontitis 3 Amoxicillin +clavulanate In refractory periodontitis 4 In all other aerobic infection Contra Indication Hypersensitivity to penicillin 25
  26. 26. Amoxicillin ....... DOSE 250 – 500 tid route of administration Orally, IM, IV 26
  27. 27. Amoxicillin ....... ADVERSE EFFECT • • • • • • • • • Amoxicillin is a safe drug un till it is hypersensitive to patient Toxicity to amoxicillin is rare Diarrhea Super infection Nausea , Epigastric distress Bleeding disdorder Urticaria Allergic reaction Bacterial resistance 27
  28. 28. CLINDAMYCIN • It is macrolide • MOA – Inhibit protein synthesis in bacterial cell wall • As a nature - Bacterio static but in high dose Bactericidal • It has ability to penetration in deeper tissue like bone and deep tissue , so has importance in treating periodontal disease 28
  29. 29. Clindamycin ........ • After oral administration Level in bone similar to level in blood Level in GCF is more than MIC required • Effective against anaerobic bacteria 29
  30. 30. Clindamycin ........ INDICATION • • • • Treatment of refractory peridontitis alone or in combination with amoxicillin Dose – 150 mg tid for 7-10 day ANUG In deep odontogenic infection Osteomyelitis 30
  31. 31. Clindamycin ........ Contra Indication Hypersensitivity Liver disorder Renal failure Blood disorder 31
  32. 32. Clindamycin ....... ADVERSE EFFECT 1. Main side effcet is Diarrhea ,gastric upset if taken in empty stomach 2. Ulcerative colitis 3. Anorexia, metallic taste 4. Allergic reaction 5. Aplastic anemia 6. Insomnia 32
  33. 33. CIPROFLOXACIN • It is first generation fluoroquinolone • Effective against gram – ve bacteria including all facultative bacteria &some anaerobic putative periodontal bacteria • Dose- 500 mg bid Dose should be change according to severity of disease • MOA Inhibit bacterial DNA synthesis • Onset of action -1 hours • Duration of action – 8 to 12 hours 33
  34. 34. Ciprofloxacin ...... INDICATION 1. In Refractory Periodontitis 2. In combination with Metronidazole effective against A. actinomycetemcomitans Non Dental Condition Typhoid Gonorrhea Skin & Soft tissue infection Urinary tract infection 34
  35. 35. Ciprofloxacin ...... • Contra Indication Hypersensitivity Special Precaution Renal disorder Epilepsy Children 35
  36. 36. Ciprofloxacin ..... ADVERSE EFFECT • Nausea vomiting Headache • Abdominal discomfort • Inhibiting metabolism of theophyllline, warfarin &anticoagulant • Photosensitivity , Hyper pigmentation, • Hypersensitivity • Insomnia 36
  37. 37. Locally Delivered of Antibiotic • Limitation of systemic therapy, mouth rinse & irrigation have, promoted for research for development of alternative delivery system • Requirement of treating periodontal disease include 1. Controlled release of drug 2. Maintained localized concentration of drug at infection site for optimum time 3. Minimal side effect 37
  38. 38. Various Locally Delivered of Antibiotic • • • • ACTISITE ARESTIN ATRIDIOX PERIO CHIP • Elyzol (Tetracyclines) Tetracyclines (Minocycline) (Metronidazole ) (Chlor hexidine) (Metronidazole ) 38
  39. 39. Powered irrigation device 39
  40. 40. Tetracycline – Containing Fiber (ACTISITE )) First local delivery product for antibiotic Feature 1. Ethylene or vinyl acetate copolymer fiber 2. Diameter 0.5 mm 3. Containing Tetracycline 12.7 mg/ 9 inch 4. When packed into periodontal pocket, it is well tolerated by oral tissue 5. For 10 day it sustains tetracycline concentration exceeding 1300 ug/ ml 40
  41. 41. ACTISITE 41
  42. 42. Actisite....... Effect Reduction in probing depth Reduction in Bleeding on probing Increase in clinical attachment level Normally no staining on teeth Reduction in plaque micro organism 42
  43. 43. Sub Gingival Delivery Of Doxycline ATRIDIOX • Atridox is gel system that incorporate the antibiotic Doxycycline (10%) in syringe able gel system • It is a Biodegradable mixture • Drug introduced Subgingivally • Applied with or without Scaling or Root planning Effect Increase in clinical attachment level Reduction in plaque micro organism Probing depth reduction 43
  44. 44. ATRIDIOX 44
  45. 45. Sub Gingival Delivery For Minocycline (ARESTIN) 1. Sub Gingival Delivery system contain 2% (w/w) Minocycline hydrochloride 2. Use as a adjuvant to Sub Gingival debridement 3. Biodegradable mixture in syringe Effect are Reduction in Pocket depth Reduction in gingival bleeding Reduction in plaque microorganism 45
  46. 46. Sub Gingival Delivery Of METRONIDAZOLE ELYZOL Containing an oil based Metronidazole 25% dental gel • ELYZOL • Applied in viscous consistency to the pocket where is liquidized by body heat and hard again contact with water • Preparation contain Metronidazole benzoate, which is converted into active substance by esterase in GCF • Effective after scaling &Root planning 46
  47. 47. Local Delivery Of Antiseptic Agent • Chlorhexidine delivery system (Perio chip) It is a resorbable delivery system periochip ,tested for Chlorhexidine gluconate • It is small chip 4 x 5 x .35 mm • Composed of Bio degradable hydrolyzed gelatin matrix Cross linked with glutraldehyde 47
  48. 48. PERIO CHIP 48
  49. 49. • It is rounded on one end so easily inserted • Perio chip released Chlor hexidine and maintain drug concentration in GCF more than 1000 ug/ml for atr least 7 day • Bio degradable in 7 to 10 day Advantage Reduction in probing depth Reduction in Bleeding on probing Increase in clinical attachment level Normally no staining on teeth A 49
  50. 50. REFERENCES  Jan Lindhe – Clinic Periodontology & Implant Dentistry, Fourth Edition.  Carranza’s Clinic Periodontology, Ninth Edition.  J D Manson & B M Eley – Outline of Periodontics, Fourth Edition.  Guru Raja Rao – Text Book Of Periodontology, Second Edition.  Periodontal Medicine, Rose, Genco, Cohen Menley 50
  51. 51. 51

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