Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

A antibiotics

2,037 views

Published on

  • Be the first to comment

A antibiotics

  1. 1. Control of Microorganisms by Antibiotics Weinberg, chapter 11
  2. 2. Properties of an Ideal Antibiotic• Bacterial specificity• Should not produce resistant strains• Does not cause allergy or toxicity• Does not cause other side effects• Does not eliminate normal oral flora• Cost effective• Hence the ideal has not been found!
  3. 3. Antibiotic Adjunctive Therapies• Treatment of aggressive periodontal diseases, chronic periodontitis, refractory periodontitis – Initial identification of pathogens – Appropriate antibiotic selection – Debridement should be carried out first• Systemic antibiotics commonly prescribed: – tetracyclines, metronidazole – amoxicillin, Augmentin, ampicillin – ciprofloxacin, clindamycin – Periostat (doxycycline)
  4. 4. Systemic Use – Concerns• Common side effects: • May be to broad – Nausea, GI upset spectrum – Diarrhea • Common oral – Rash manifestations:• Resistant bacteria – Black hairy tongue• Poor client – Oral candidiasis compliance
  5. 5. Controlled Release Agents• Work by suppressing destructive enzymes produced during inflammatory process or suppressing microbes• Considered for localized periodontal sites• Systems available include: – Actisite (tetracycline fiber) – Atridox (doxycycline gel) – Arestin (minocycline microsphere)
  6. 6. Advantages of Controlled Release Agents• Client compliance not an issue• GCF concentration greater than serum levels• Delivery is localized – reduces systemic effects• Reduced side effects
  7. 7. Tetracycline• Clinical Use: – Refractory periodontitis – Localized aggressive periodontitis – Growing trend to use combination therapies – more effective – Systemic & local delivery systems
  8. 8. Tetracycline• Mechanism of action: – Bacteriostatic, broad spectrum – More effective against gram-positive bacteria – However, A.a. highly susceptible – Non-antibacterial properties: • Inhibits production & secretion of collagenase • Inhibits bone resorption
  9. 9. Tetracycline• Mechanism of action: – Antibacterial properties: • Inhibits growth & multiplication of bacteria• Dosage: – 250 mg for 2 weeks
  10. 10. Tetracycline – Side Effects• Intrinsic tooth • Interferes with staining bactericidal activity of• GI upset, abdominal penicillins & pain cephalosporins• Diarrhea, vomiting • Reduces effect of• Fungal overgrowth BCP• Resistant bacterial strains
  11. 11. Actisite® Periodontal Fiber• Clinical use: – Pockets measuring ≥ 5 mm, bleed on probing – Localized treatment for sites that have not responded to previous mechanical therapy• How supplied: – Cartons of 4 or 10 fibers – 23 cm in length – 12.7 mg tetracycline hydrochloride – Stored at room temperature
  12. 12. Actisite®• Application: – Treat one quadrant or one side of mouth at a time – Client may request anaesthesia – Fiber inserted into pocket (circumferential or not) • Takes about 10 minutes/tooth – Some control of saliva – Should contact pocket base
  13. 13. Actisite®• Application: – Sealed in place with adhesive • Apply in thin even line along gingival margin • Surgical dressing not necessary but has been used – Removed 7-10 days after placement • Curette and/or cotton pliers • Fiber comes out in mass or pieces • Debride areas as necessary – Tissue may appear red following removal
  14. 14. Actisite®• Adverse effects: – Discomfort – Local erythema – Little systemic reaction – Used with caution in client with history of candidiasis – Application around 12+ teeth may result in oral candidiasis
  15. 15. Actisite®• Client instructions: – Avoid brushing & flossing – Use antimicrobial rinse • Use of CHX may have syngerstic effect – Avoid hard or crunch foods, stick foods, chewing gum
  16. 16. Actisite®• Clinical Efficacy: – Reduction in bleeding on probing and pocket depth • More significant reductions in deeper pockets – Reduction in periodontal pathogens – Effects of fiber on bone loss, tooth mobility or tooth loss not established
  17. 17. Metronidazole• Clinical use: – Refractory periodontitis (when combined with amoxicillin or Augmentin) – Necrotizing ulcerative gingivitis – Moderate – severe periodontitis – Aggressive periodontitis (LAP) when combined with amoxicillin or Augmentin – Following perio surgery if barrier membranes in place – suppresses P.g.
  18. 18. Metronidazole• Mechanism of action: – Bactericidal antimicrobial – Disrupts DNA synthesis leading to cell death – Selectively kills bacterial associated with periodontal disease – Susceptible bacteria include: • Fusobacterium, Bacteroides • Peptostreptococcus • Treponema, Campylobacter • Veillonella
  19. 19. Metronidazole – Side Effects• GI disturbances • Nausea, diarrhea• Headache • Stomatitis• Dry mouth • Avoid alcohol when• Candida infections taking: acute nausea,• headache, vomiting Metallic taste • May decrease effects of BCP
  20. 20. Metronidazole• Clinical Considerations: – GCF concentrations > blood serum levels – When combined with oral hygiene & debridement = beneficial effect on periodontitis • Periodontal surgery may not be necessary – Doxycycline may be substituted for metronidazole • If client can’t abstain from alcohol
  21. 21. Before & AfterTreatment with Metronidazole• Probing depth of 6 • Tissue shrinkage & mm recession
  22. 22. Before & After Treatment with Metronidazole• 6 mm probing depths • Surgery has not been required
  23. 23. Metronidazole• Some evidence of bone gain – client 2.5 years after initial debridement and use of metronidazole
  24. 24. Metronidazole• Dosage: – 250 mg tid for 7-10 days – 500 mg bid for 1-2 weeks• Doxycycline – 100 mg per day or BID• Metronidazole and amoxicillin or Augmentin – 250 mg (of each) TID for 7-10 days
  25. 25. Arestin™• Clinical use: – Periodontitis with pockets P 5 mm• How supplied: – Box containing 2 trays each containing 12 cartridges – Cartridge contains 1 mg of minocycline (semisynthetic tetracycline derivative) microencapsulated in Poly dry powder – Cartridge inserted into a cartridge handle
  26. 26. Arestin ™• Preparing for Arestin Premeasured, premixed, no refrigeration necessary
  27. 27. Arestin ™• Mechanism of action: – Broad spectrum – Bacteriostatic – GCF levels maintained at high levels for at least 14 days
  28. 28. Arestin ™• Application: – Insert tip to base of periodontal pocket – Expel powder into pocket – Bioadhesive microspheres activate & adhere on contact with moisture – Cartridge contains enough Arestin for one periodontal pocket – Clinical trials: 30 sites treated in less than 10 minutes – Dressings or adhesives not required
  29. 29. Arestin ™• Adverse effects: – Headache – Pain – Mouth ulceration – Slu syndrome – Stomatitis
  30. 30. Arestin ™• Client instructions: – Do not eat hard or sticky foods for 1 week – Postpone brushing for 12 hours – Do not use interproximal cleaning aids for 10 days
  31. 31. Arestin ™• Clinical efficacy: – 27,000 sites treated, n=748
  32. 32. Arestin ™• Clinical efficacy: – Arestin with debridement demonstrated 27% greater pocket reduction in molars compared to debridement alone • Mean reduction of 2 mm (pockets 7 mm +) – Effective in furcations

×