Anti infective Therapy 6/4/2020 -لثة 10سيمسيتر

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Systemic administration of

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Indications

1. Actively, aggressive progressing

periodontitis.

2. Non-responding cases (Refractory) -------

--------- (microbial analysis).

3. Medically compromised patients.

4. Chronic periodontitis ------ (unclear).

5. ANUG.

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6. Premedication of patients who have

medical problems requiring prophylactic

systemic antibiotic coverage

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Tetracyclines

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Tetracyclines

• Pharmacology

Tetracyclines

• Are Effective in treating periodontal disease

because

1. ؟؟؟؟

Tetracyclines

• Indication: they are used as adjuncts in the

treatment of:

a. Localized aggressive periodontitis because

effective against.

b. A. actinomycetemcomitans frequent causative

organism in LAP and is tissue invasive

c. Other Aggressive periodontitis and refractory

periodontitis.

Tetracyclines

• Adverse Effect

• ؟

• ؟

• ؟

• ؟

Tetracyclines

• Specific Agents

• Tetracycline,

• minocycline,

• doxycycline and all semi synthetic members of

the tetracycline group have been used in

periodontal therapy.

Metronidazole

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Metronidazole:-

◦ It is bactericidal to anaerobic organisms, disrupt

bacterial DNA synthesis in conditions in which a

low reduction potential present

◦ It is effective against anaerobes such as PG, PI.

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Metronidazole:-

◦ It is not the drug of choice for treating A.a

infections. However, it is effective against A.a

when used in combination with other antibiotics

(Amoxicillin or Augmentin)

◦ It is used to treat CP, NUG, AP

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Metronidazole:-

◦ dose of metronidazole ؟

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Metronidazole

• Side Effects

؟.1

؟.2

Clindamycin

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Clindamycin:-

◦ Clindamycin is bacteriostatic & it interferes with

protein synthesis by binding to bacterial ribosomes

◦ It is effective against anaerobic bacteria (PG)

◦ Clinical Usage

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Clindamycin • Side Effects

• Clindamycin has been associated with pseudomembranous

colitis more often than other antibiotics, therapy limiting its

use. When needed, however, it can be used with caution.

• Diarrhea or cramping that develops during the use of

clindamycin may be indicative of cholitis, and clindamycin

should be discontinued.

• If symptoms persist, the patient should be referred to an

internist.

Penicillins

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Penicillins • Pharmacology

• Penicillins are the drugs of choice for the treatment of many

serious infections in humans and are the most widely used

antibiotics.

• They inhibit bacterial cell wall production and therefore are

bactericidal.

• Side Effects

• Penicillins may induce allergic reactions and bacterial

resistance; up to 10% of patients may be allergic to

penicillin.

Amoxicillin

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Amoxicillin:-

◦ It is semisynthetic pencillin with an extended

antimicrobial spectrum that includes gram+ve,

gram –ve bacteria

◦ It is susceptible to pencillinase, a β lactmase

produced by certain bacteria that breaks the

penicillin ring structure lead to renders penicillins

ineffective

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Amoxicillin- Clavulanate

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Macrolides:-

◦ Erythromycin:

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Macrolides:-

• Spiramycin

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Azithromycin

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Ciprofloxacin:-

◦ It is a quinolone active against gram-ve rods,

including all facultative and some anaerobic

putative periodontal pathogens

◦ Ciprofloxacin therapy may facilitate the

establishment of a microflora associated with

periodontal health (it has minimal effect on

streptococcus species)

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Combination Antibiotic Therapy

Serial and Combination Antibiotics

therapy

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Common antibiotic regimens used for

treatment of periodontal diseases:

Metronidazole-------------------------500 mg

3 times daily X 8 days

Clindamycin----------------------------300 mg

2 times daily x 8 days

Ciprofloxacin--------------------------500 mg

2 times daily x 8 days

Doxycycline hyclate------------------100 mg

every 12 h on 1 st day,

Then 100 once daily

Azithromycin---------------------250-500 mg

once daily x 3 days

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Common antibiotic regimens used for

treatment of periodontal diseases:

Combination therapy

Metronidazole-amoxcillin-----------500

mg 3 times daily x 8 days

Metronidazole-ciprofloxacin-------500 mg

2 times daily x 8 days

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Local delivery and host

modulation therapy

Systemic antibiotics have

advantages:؟؟؟

1- Tetracycline fibers (Actisite):

Local delivery devices

2- Metronidazole gel (Elyzol)

Local delivery devices

3- Chlorohexidine chip (Periochip)

Local delivery devices

4- Doxycycline polymer (Atridox)

Local delivery devices

5- Minocycline ointment (Periocline)

Local delivery devices

However, local antimicrobial therapy

should not be used routinely in situations

when efficacious results can be

accomplished with scaling and root

planing only.

N.B.

Host response modulation

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