W4-systemic antibiotics.pdf

24.10.2023 PERIODONTOLOGY Systemic Anti-Infective Therapy for Periodontal Diseases Assist. Prof. Ece RAKUNT TOPTAŞ Department of Periodontology [email protected] 1 Resources Newman and Carranza’s Clinical Periodontology 2 1 24.10.2023 Learning Objectives • Evaluate the rationale for...

24.10.2023 PERIODONTOLOGY Systemic Anti-Infective Therapy for Periodontal Diseases Assist. Prof. Ece RAKUNT TOPTAŞ Department of Periodontology [email protected] 1 Resources Newman and Carranza’s Clinical Periodontology 2 1 24.10.2023 Learning Objectives • Evaluate the rationale for use of anti-infective agents as adjuncts to periodontal therapy. • List the clinical indications for use of anti-infective agents. • Evaluate the pharmacology of anti-infective agents indicated as adjuncts to periodontal therapy 3 Systemic Anti-Infective Therapy Bacteria Supragingival biofilm Complexpathogenic Bone destruction Periodontal pocket Highly structured, complex biofilm Subgingival Patient cannot reach to clean 4 2 24.10.2023 Systemic Anti-Infective Therapy Mechanical treatment Patient cannot reach Systemic-antienfective therapy Antibiotic strength that is 500 times greater than the usual therapeutic dose may be needed to be effective against bacteria that have become arranged in biofilms!!!!!!!! 5 Systemic Anti-Infective Therapy LOGICAL: Periodontal pocket treatment à mechanically anti-infective Systemic and local anti-infective therapy à can reduce bacterial challenge to periodontium Chemotherapeutic agents can modulate the host's immune response to bacteria and reduce the host's self-destructive immunologic response to bacterial pathogens, thereby reducing bone loss. 6 3 24.10.2023 Definitions: • Anti-infective agent : Chemotherapeutic agent that acts by reducing the number of bacteria present. • Antibiotic: Naturally occurring, semisynthetic, or synthetic type of antiinfective agent that destroys or inhibits the growth of select microorganisms, generally at low concentrations. • Antiseptic : Chemical antimicrobial agent that can be applied topically or subgingivally to mucous membranes, wounds, or intact dermal surfaces to destroy microorganisms and inhibit their reproduction or metabolism. 7 Systemic Administration of Antibiotics (AB) • The purpose of a systemic administration of antibiotics is to reduce the number of bacteria present in the diseased periodontal pocket; this is often a necessary adjunct for controlling bacterial infection, because bacteria can invade periodontal tissues, thereby making mechanical therapy alone sometimes ineffective. 8 4 24.10.2023 Remember!! Bacteriostatic Antibiotics Bactericidal Antibiotics •Pharmacologic agents that prevent the growth of bacteria •Tetracycline, clyndamycin •pharmacologic agents that actually kill the bacteria •Penicillin, metronidazol 9 Antibiotics in periodontal treatment An ideal antibiotic for use in the prevention and treatment of periodontal disease should be : Specific for periodontal pathogens Allogenic Nontoxic Substantive No ideal antibiotics exist for treatment of periodontal diseases Not in general use for the treatment of other diseases Inexpensive 10 5 24.10.2023 Antibiotics in periodontal treatment Although oral bacteria are susceptible to many antibiotics, no single antibiotic at the concentrations achieved in body fluids inhibits all putative periodontal pathogens. A combination of antibiotics may be necessary to eliminate all putative pathogens from some periodontal pockets 11 Antibiotics in periodontal treatment 12 6 24.10.2023 Common antibiotics Regimen Used to Treat Periodontal Diseases 13 Antibiotic selection The treatment of an individual patient must be based on The patient’s clinical status, The nature of the colonizing bacteria, The ability of the agent to reach the site of infection, The risks and benefits associated with the proposed treatment plan 14 7 24.10.2023 The clinician is responsible for choosing the correct antimicrobial agent: Other concerns: Some adverse reactions; allergic or anaphylactic reactions superinfecti ons of opportunist ic bacteria, developme nt of resistant bacteria interactions with other medication s upset stomach, nausea, and vomiting the cost of the medication the patient’s willingness and ability to comply with the proposed therapy 15 Tetracyclines • Tetracyclines have the ability to concentrate in the periodontal tissues and inhibit the growth of Aggregatibacter actinomycetemcomitans. • Exert an anticollagenase effect that can inhibit tissue destruction and may help with bone regeneration!!!!! 16 8 24.10.2023 Tetracyclines: Have been investigated as adjuncts for treatment of LAP (lokalized aggressive periodontitis) A.a invades tissue • difficulty in mechanical removal systemic tetracycline • eliminate tissue bacteria arrest bone loss and supress a.a levels • +SCRP 17 Tetracyclines: 1) Tetracycline 2) Minocycline 3) Doxycyline Semi-synthetic forms of tetracycline group used in periodontal treatment 18 9 24.10.2023 Tetracyclines: Tetracycline Minocycline Doxycyline 4x1 2X1 1x1 Absorbtion affected with calcium! Metal ions antacids Similar side effects 1. day: 2X1 2. day: 1X1 GIS Photosen sitivity Hypersen sitivity Dizziness Headache Tooth discolor ation Vertigo! Less affected by Ca, metal,antacid s Similar side effect Photosensitivity ⇈ 19 Metronidazole • Anerobic m.o!! • Disrupt bacterial DNA synthesis • Metronidazole is effective against A.a when used in combination with other antibiotics. • Metronidazole is also effective against P. gingivalis and P. intermedia 20 10 24.10.2023 Metronidazole Clinical use: • Necrotizing gingivitis!!!!! • Chronic periodontitis • Aggressive periodontitis 250 mg 3X1 for 7 daysà most popular regimen 21 Metronidazole Side effects: • Alcohol xxà antabuse effect! (disulfram effect) • Blocks warfarin (anticoagulant therapy!!!) • Lithium!! 22 11 24.10.2023 Penicillines • Amoxiciline (500 mg 3x1 8 days) • Amoxiciline +clavulanate pottasium Useful in periodontal therapy (Augmentin) (2X1) Penicilline allergy!!!!! 23 Other antibiotics Clyndamycine: • In case of penicilline alergy! Ciprofloxacin: • Ciprofloxacin is the only antibiotic in periodontal therapy to which all strains of A. actinomycetemcomitans are susceptible. • It has also been used in combination with metronidazole. 24 12 24.10.2023 Other antibiotics Macrolids: Erytromicin xxxxx Spiramycin Min effect Azithromycin Future studies needed 25 Serial or combination Antibiotic therapy • Because periodontal infections may contain a wide variety of bacteria, no single antibiotic is effective against all putative pathogens. • These “mixed” infections can include a variety of aerobic, microaerophilic, and anaerobic bacteria, which may be both gram negative and gram positive. In these cases, it may be necessary to use more than one antibiotic, either serially or in combination. 26 13 24.10.2023 Serial or combination Antibiotic therapy Bacteriostatic+ bacterocidal à Serial! Bacteriostatic + bacteriostatic à Combined Bactericidal + bactericidal à Combined 27 Serial or combination Antibiotic therapy *Amox-Clav + Metronidazol à Combined (2X1) + (3x1) Ciprofloxasin + Metronidazoleà Combined (2x1) (2x1) 28 14 24.10.2023 29 Thank you for listening… 30 15