Various Types Of Antibiotics In Detail Used In Treatment Of Periodontal Diseases

Various Types Of Antibiotics In Detail Used In Treatment Of Periodontal Diseases

Following are the guidelines for use of antibiotics in periodontal therapy:

• The clinical diagnosis and situation dictate the need for possible antibiotic therapy as an adjunct in controlling active periodontal disease. The patient’s diagnosis can change over time.
• Continuing disease activity, as measured by continuing attachment loss, purulent exudate, and continuing periodontal pockets of 5 mm or greater that bleed on probing, is an indication for periodontal intervention and possible microbial analysis through plaque sampling. Also cases of refractory or aggressive periodontitis may indicate the need for antimicrobial therapy.
• When used to treat periodontal disease, antibiotics are selected based on the patient’s medical and dental status. Current medications and results of microbial analysis, if performed.
• Microbiologic plaque sampling may be performed according to the instructions of the reference laboratory. The samples usually are taken at the beginning of an appointment before instrumentation of the pocket. Supragingival plaque is removed, and an endodontic paper point is inserted subgingivally into the deepest pockets present to absorb bacteria in the loosely associated plaque. This endodontic point is placed in reduced transfer fluid and sent overnight to the laboratory. The laboratory will then send the referring dentist a report that includes the pathogens present and any appropriate antibiotic regimen.
• Plaque sampling can be performed at the initial examination, root planning, reevaluation, or supportive periodontal therapy appointment. Clinical indications for microbial plaque testing include aggressive forms of periodontal disease, diseases refractory to standard mechanical therapy, and periodontitis associated with systemic conditions.
• Antibiotics have also been shown to have value in reducing the need for periodontal surgery in patients with chronic periodontitis.
• Some studies have shown attachment gain with antibiotics given as monotherapy. However, the evidence is insufficient at present to recommend systemic antimicrobial therapy as monotherapy. Therefore, systemic antimicrobial therapy should be an adjunct to a comprehensive periodontal treatment plan. Debridement of root surfaces, optimal oral hygiene, and frequent supportive periodontal therapy are important parts of comprehensive periodontal therapy. Chemotherapeutic adjuncts include locally placed subgingival anti-infective agents, chlorhexidine rinse after debridement, and home intraoral irrigation with or without chemotherapeutic agents. Chlorhexidine gluconate is effective as an antiplaque rinse to reduce gingivitis but not as a subgingival irrigant to reduce periodontal pocketing. Chlorhexidine gluconate anti-infective activity is greatly reduced in the presence of organic matter in the subgingival periodontal pocket. Some evidence suggest that povidone-iodine (Betadine) may be an effective antibacterial agent when used directly into the periodontal pocket, even at low concentrations, but further studies are needed to substantiate these data. Povidone-iodine must be used with caution in patients sensitive to iodine, although the sensitization rate is low. It also should be used with caution in patients who are pregnant or lactating.
• Slots et al. described a series of steps using antiinfective agents for enhancing regenerative healing. They recommend starting antibiotics 1 to 2 days before surgery and continuing for a total of at least 8 days. However, the value of this regimen has not been well documented, and further studies are encouraged.
• Using evidence-based techniques, meta-analysis has shown statistically significant improvements in attachment loss when tetracycline and metronidazole are used as adjuncts to scaling and root planning.

Antibiotics in Treatment of Periodontal Diseases

Following are the antibiotics are used commonly in the periodontal diseases:

• The drugs more extensively investigated for systemic use include tetracycline, minocycline and doxycycline, erythromycin, clindamycin, ampicillin, amoxicillin and the nitroimidazole compounds, metronidazole and ornidazole.
• The drugs investigated for local application include tetracycline, minocycline, doxycycline, metronidazole and chlorhexidine.

Penicillins

• Penicillins were the first group of antimicrobials used in periodontal therapy.
• Penicillins are bactericidal but induce allergic reactions.

Tetracyclines

• Tetracycline HCl became a popular choice during 1970s due to its broader spectrum of activity than penicillins, ability to inhibit collagenase activity, which is thought to interfere with the breakdown of periodontal tissues, firm adsorption to tooth surfaces and slow release over time.
• Most of subgingival microorganisms are susceptible to tetracyclines at a minimum inhibitory concentration of 1-2 mg/ mL.

Doxycyclines

• Doxycyclines are the semisynthetic tetracyclines.
• Doxycycline as compared to tetracyclines does not absorbed by calcium, milk and antacids and show better compliance.
• Doxycyclines is recommended in a 100 mg dosage twice daily for first day and then 100 mg four times a day.

Metronidazole

• Metronidazole is a powerful amebicide.
• The drug has selective antimicrobial features against the obligate anaerobes.
• Metronidazole should be given 200 mg for four times a day for one week or 400 mg three times a day for one week.
• Metronidazole is the first choice of drug to treat ANUG and aggressive periodontitis.

Azithromycin

• Azithromycin is taken up by gingival epithelial cells and penetrates fibroblasts and phagocytes. It is transported and released directly into site of inflammation through phagocytosis.
• Azithromycin initial loading dose is 500 mg followed by 250 mg/day for 5 days.