Antimicrobials Flashcards
(29 cards)
What are the advantages of systemic Antimicrobials?
Simeple
Cheap
Multiple sites
Eradiation of other sites eg tongue
Where can bacteria be located?
Root surface Pocket lumen Root dentine Soft tissues Oral reservoirs EO resevoirs
What are the disadvantages of systemic ?
Safety Emergence of bacteria resistance Allergy (1/10 pencillin) Superinfection with opputunistcs Toxic side effect Interaction with other drugs Compliance
What are the RF to syestmic antimicrobialsm?
Poor oh Smoking Systemic disease Drug interactions Side effects Compliance
What are the indications to systemic antimicrobials?
Aggressive perio
Necrotising perio
Perio abscess
What will happen if you prescribe systemic antibiotics without RSD?
Multiple abscess
Topoll et al 1990
Which Antimicrobials do we use in perio?
Tetracyclines
Metron
Penciillins
(Spitsmycin, vancomycin, kanamycin)
What are the properties of tetracyclines?
Bacteriostatic Anticollagenase Anti inflam Inhibits bone resorption Promote fibroblast attachment to root surface
Which bactera are very susceptible to tetracyclines?
Aa
What dose is tetracycline given at?
250mg qds three weeks
What must you combine when using tetracyclines?
OHI
RSD
What is the diasadvantage with tetracycline?
Staining
EM
Re activation of disease in 25% of aggressive! chronic
Aa still found in 56% of aggressive
What is metron used for?
Gram neg anaerobes eg P Gingivalis, P intermedia
NOT AA
What is the perio pill?
250mg tds 7 days amox
200mg tds 7 days metron
If allergic then ciproflucloxillin 250mg bd 7 days
T/F perio pill works against Aa?
T
Which host modulating drugs are there?
Anti collagenases: perio stat
Anti inflam:
Anti oxidants stimulate phagocytic cels and immunity
What is perio stat?
Anti collagenases
Low sub lethal dose of doxycycline 20mg bd 3months -1 year
Reduces collagenases in GCF and gingiva
Doc concentrates in the GCF, wide spectrum and substantive to dentine and cementum
Reduces BOP and PD in chronic perio
NO EFFECT ON BACTERIA
How effective is perio stat?
Preshaw et al 2004
Reduction in pocket depths seen as early as three months an maintain for 9 months
Which local antibiotics are there?
Controlled release devices eg hollow fibres, acrylic, monolithic fibres, ethyl cellulose
What are the advantages of local Antimicrobials therapy?
High local concentration Site specific Not dependant on compliance Penetrates biofilm and endotoxins Low toxicity Less unwanted side effects
What are the disadvantages to local Antimicrobials?
Time Hypersensitivity Bacterial resistance Placement and retention Bacterial eradication Multiple sites Compatibilty of delivery vehicle system with periodontal tissues
Which local agents are there?
Dentomycine: 2% minocycline
Elyzol: 25% metron
Actisite: 25% tetracycline fibres
Arestin: 1mg minocycline hydrochloride microspheres
Periochip : biodegradable CHX chip for pickets more than 5mm
What is dentoycine?
Lipid based gel
Used as an adjunct
Not as good a actisite
What is elyzol?
25% metron
As effective as Subginginval scaling on PPD and BOP
But sticky and lost easily
