3 Perio II (Exam 2): Systemic and Local Antibiotics in periodontics

•Specific

•Allogenic

•Non-toxic

•Substantive

•Affordable

•Not in general use

The ideal antibiotics would be:

bacteria is organized in biofilm

What is the reason that we cannot use antibiotics to cure gingival/perio diseases?

false

t/f: it is possible to use antibiotics alone as therapy for gingival/perio diseases

overuse/abuse

What is the most important predictor of antibiotic resistance?

more that 500

In order to rectify gingival/perio diseases driven by biofilm, you would have to take _______ times the recommended amount of antibiotics

Gingival Crevicular Fluid (GCF)

What is the target of antibiotics as adjunctive therapy for gingival/perio diseases?

some bacteria invade the tissue as a virulence factor

What is the justification of adding antibiotics on to some perio disease therapy?

tetracycline, minocycline & doxycycline

What are the 3 tetracyclines used in dentistry?

Bacteriocidal

All of the following are true about tetracyclines, EXCEPT:

- Bacteriocidal

- Gram + Gram -

- Against A. actinomycetemcomitans

-Anti-collagenase effect

- GCF concentration 2-10 x serum

tooth discoloration

What is the main side effect fro Tetracyclines:

250 mg QID

dose for Tetracycline:

100 mg BID

dose for Minocycline:

100 mg qd (except 1st day, bid)

dose for Doxycycline:

against A. actinomycetemcomitans

All of the following are true about Metronidazole, EXCEPT:

- Antiprotozoal

- Bactericidal/Anaerobes

- against P. gingivalis & P. intermedia

- against A. actinomycetemcomitans

- Side effects w/ Warfarin, Alcohol, Lithium

Warfarin

Alcohol

Lithium

Metronidazole is contraindicated with the use of what drugs:

10%

What % of the population has a penicillin allergy?

Amoxicillin

This penicillin is:

•Extended spectrum

•Gram + Gram -

•Vulnerable to β-lactamase

•500 mg tid

Augmentin

This penicillin is:

•Amoxicillin + clavulanate potassium

•Resistant to β-lactamase

•500 mg tid

Amoxicillin + Clavulanate Potassium

What two medications make up Augmentin:

500 mg TID

Dose for Amoxicillin and Augmentin:

Clindamycin

This medication is contraindicated in pts w/ Hx of Pseumembranous colitis:

Clindamycin

ID the antibiotic:

•Bacteriostatic/Bactericidal

•Anaerobes

•Affinity to osseous tissue

•150/300 mg tid

•When penicillin allergy

•Side effects: ...

--Pseumembranous colitis

--Not when Hx of colitis

--GI symptoms à discontinue

Ciprofloxacin

This antibiotic has activity against ALL A. actinomycetemcomitans species:

Ciprofloxacin

ID the antibiotic:

•Quinolone

•Bacteriostatic/Bactericidal

•Gram – rods, all facultative anaerobes

•works against A. actinomycetemcomitans

•Minimal effect of Streptococcus spp

•Side effects: …

--Toxicity issues

--Increases warfarin activity

Azithromycin

ID the antibiotic:

•Bacteriostatic/Bactericidal

•Anaerobes & gram - bacilli

•Actively transported to sites of inflammation by phagocytes

•250 mg qd (except 1st day, bid)

• caution in CVD patients!

true

t/f: Short-term antibiotic treatment has differing long-term impacts on the human throat and gut microbiome

4

Although the diversity of the microbiota subsequently recovered to resemble the pre treatment states, the microbiota remained perturbed in some cases for up to____ years post treatment

not recommended

Are antibiotics recommended to help treat Gingival diseases:

- not recommended

- depends on systemic complications

- use is recommended

depends on systemic complications

Are antibiotics recommended to help treat Necrotizing gingivitis:

- not recommended

- depends on systemic complications

- use is recommended

not recommended

Are antibiotics recommended to help treat Generalized Stage III Grade B Periodontitis:

- not recommended

- depends on systemic complications

- use is recommended

use is recommended

Are antibiotics recommended to help treat Generalized Stage III Grade C Periodontitis:

- not recommended

- depends on systemic complications

- use is recommended

use is recommended

Are antibiotics recommended to help treat Localized Stage III/IV Grade C Periodontitis with molar incisor pattern:

- not recommended

- depends on systemic complications

- use is recommended

depends on systemic complications

Are antibiotics recommended to help treat Necrotizing Periodontitis:

- not recommended

- depends on systemic complications

- use is recommended

depends on systemic complications

Are antibiotics recommended to help treat Periodontitis as a manifestation of systemic disease:

- not recommended

- depends on systemic complications

- use is recommended

not recommended

Are antibiotics recommended to help treat Periodontal Abscess

- not recommended

- depends on systemic complications

- use is recommended

Metronidazole + Amoxicillin

What combination therapy is recommended to help treat periodontal disease?

Metronidazole + Ciprofloxacin

What combination therapy is recommended to help treat periodontal disease in pts allergic to penicillins?

•Localized lesion

•Non-responsive to therapy

•5 mm pocket

•Inflammation..

•Peri-implant disease

What are the indications for using local delivery antibiotics:

PerioChip

ID the treatment:

•Chlorhexidine gluconate

•Biodegradable hydrolyzed gelatin matrix (vehicle)

•GCF concentration: 100 μg/ml

•7 days

Atridox

ID the treatment:

•10% doxycycline

•Gel (vehicle)

• gives > 1 application

Arestin

ID the treatment:

•2% Minocycline

•Gel (vehicle)

•1 application

TNF-α

IL-1

IL-6

IL-8

PGE2

MMPs

What products are the hosts overproduced pro-inflammatory/ destructive mediators and enzymes:

Periostat

ID the treatment:

•Sub-Antimicrobial Doxycycline

-Target MMPs

•< MIC

•20 mg bid

•3-9months

•Only FDA approved systemic HMT for periodontitis

- MMPs

- Prostaglandin E2

- Osteoclasts

What 3 main molecules/enzymes Sub-Antimicrobial Doxycycline (Periostat) target?

tetracycline

which oral Abx accumulates the most in the gingival crevicular fluid?

- penicillin

- amoxicillin

- tetracycline

- metronidazole

SRP + MTZ + AMX

which of the following is the best for decreasing red complex bacteria?

- SRP

- SRP + MTZ

- SRP + MTZ + AMX