antibiotics in perio

7/28/2019 Antibiotics in Perio

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ANTIBIOTICS INPERIODONTCS


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ANTIBIOTIC

chemical substance originally produced bymicroorganism,either retard the growth ofmicroorganism

or result in their death

some antibiotics are chemically

synthesized or semi synthesized


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An Ideal Antibiotcs Should be

1. Selective and effective against micro organism

2. Bactericidal more than bacteriostatics

3 Not ineffective as a result of bactericalresistance

4. Not be inactivated by enzyme, plasma, protein

or by body fluid

5. Maintained for sufficient period in blood plasma

6. Have minimal adverse effect


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Classification of Antibiotic

Based on chemical structure

1 sulfonamides- sulfadiazine, PAS

2 Quinolones - ciprofloxacin , Nalidixic acid

3 Tetracyclines Doxycycline, Tetracycline

4 Aminoglycosides Gentamycin,

streptomycin

5 Macrolides Erythromycin, Roxithromycin,

Azithromycin

6 -lactam antibiotic- Penicillins

Cephalosporacin


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7 Nitroimidazoles - Metronidazole,

Tinidazole

8 Imidazoles derivatives- ketoconazole,

9 Polypeptides Antibiotic Bacitracin

Polymyxin -B

10 Nicotinic acid derivatives

Isoniazid, Pyrazinamide


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Common Antibiotic used in

PERIODONTCSTetracycline

Metronidazole

AmoxicillinClindamycin

Cephalosporin

Ciprofloxin


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Antibiotic Resistance

Microorganism are some time resistant orunaffected by an antibiotic

Resistance can be

Natural, (before contact with drug)Acquired, (developed after exposure to drug

The development of acquired resistance

is genetic, with change in DNA , and isinherited by subsequent generation


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* Micro organism are resistance to particular drugfrequently are resistance to other chemicallyrelated antimicrobial agent

This is referred as Cross Resistance

* In antibiotic resistance implies

In activation of antibiotic by bacterial

enzymeDevelopment of alternate pathway of

drug metabolism by bacteria

Biochemical alternation in the bacteria that

prevent the uptake or binding of the antibiotic


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TETRACYCLINE

Widely used in treatment of periodontics

Broad spectrum antibiotics

Effective aganist remove > gram- ve MOA - inhibiting protein synthesis in

bacteria

Bacteriostatics, effective against rapidly

multiplying bacteria


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Tetracycline Effective in treating

periodontal disease because

1. Their concentration in GCF is 2 to 10 times

more than blood serum

2. Ability to concentrate in POCKET

3. Inhibit the growth of

Actinobacillus actinomycetemcomitans

4. Have anti collagenase effect inhibiting tissuedestruction

5. Increase bone regeneration


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Classification of Tetracycline

based on generation

Group 1 Chlortetracycline

oxy tetracycline

Tetracycline

Group 2 Demeclocycline

Methacycline

LymecyclineGroup 3 Doxycycline

Minocycline


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Tetracyclines..........

INDICATION

Dental condition

1. Localized aggressive periodontitis

because effective against

A. actinomycetemcomitans

2. other Aggressive periodontitis.3. Refractory periodontitis.


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Tetracyclines..........

Other conditionMixed bacterial infection

- in respiratory infection

- in genital urinary infection- G I T infection

Contra indication

Pregnancy

Feeding mother

Liver disorder

Kidney disorder

T t li


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Tetracyclines.........

Adverse Effect

Permanent discoloration of teeth in offspring dueto administration of drug during last half ofpregnancy

Administration of drug in 1-st 6 years of life

Teratogenicty

Photosensitivity

GIT disorder

Nausea, Vomiting,

Diarrhea

Epigastric distress

Drecress absortion of vitamin k


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Tetracyclines.......

Lethal hepatic toxicity

if tetracycline use in renal disorder

Fancony type syndrome if outdatedtetracycline Use in in renal disorder

Now tetracycline less use in dental &medical, replace by more effectiveother combination antibiotic


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Tetracycline Staining


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METRONIDAZOLE1. It is effective against anaerobic

bacteria& anaerobic parasite

2. Anaerobic bacteria both gram +ve &

gram ve3. MOA inhibiting the growth of bacteria

by inhibit the bacterial DNA synthesis

4. On set of action 8 hours5. Duration of action - 24-48 hours

I


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METRONIDAZOLE .......

More effective against obligate anaerobic

gram ve bacteria

DOSE

Orally - 200- 400 mg tid

For 7-10 day

Available as

Metrogyl 400 mg

Flagyl 400 mg


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METRONIDAZOLE ..........

Adverse Effect

1. Abdominal problem

Severe cramp, Nausea, Vomiting,

Diarrhea2. Metallic taste in mouth

3. Headache disorder

4. Dry mouthNot use as mono therapy for treatment of

periodontal disease


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Penicillins

These are B lactam antibioticTypes

Penicillin G (Benzyl Penicillin )

acid labile destroyed by gastric acidPenicillin- V acid stable ( given orally )

Penicillinase resistance penicillin

Methicillin , cloxicillin, OxacillinExtended spectrum Penicillin

amphicilin, amoxicillin, bacampicillin


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AMOXICILLIN

Amoxicillin is a semi synthetic antibiotic

Known as Broad spectrum penicillin

Effective against gram- ve bacteria MOA of action Inhibit synthesis of

bacterial cell wall

Onset of action - 1-2 hours Duration of action - 8 hours


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Amoxicillin .......ADVERSE EFFECT

Amoxicillin is a safe drug un till it ishypersensitive to patient

Toxicity to amoxicillin is rare

Diarrhea Super infection Nausea , Epigastric distress

Bleeding disdorder Urticaria Allergic reaction

Bacterial resistance


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CLINDAMYCIN

It is macrolide MOA Inhibit protein synthesis in bacterial

cell wall

As a nature - Bacterio static but in highdose Bactericidal

It has ability to penetration in deeper tissue

like bone and deep tissue ,

so has importance in treating periodontal

disease


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Clindamycin ........

After oral administration

Level in bone similar to level in blood

Level in GCF is more than MIC required

Effective against anaerobic bacteria


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Clindamycin .......

ADVERSE EFFECT

1. Main side effcet is

Diarrhea ,gastric upset if taken in

empty stomach

2. Ulcerative colitis

3. Anorexia, metallic taste

4. Allergic reaction

5. Aplastic anemia

6. Insomnia


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Ciprofloxacin ......

INDICATION

1. In Refractory Periodontitis

2. In combination with Metronidazole effectiveagainst A. act inom ycetemcom itans

Non Dental Condition

Typhoid

Gonorrhea

Skin & Soft tissue infectionUrinary tract infection


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Ciprofloxacin ......

Contra Indication

Hypersensitivity

Special Precaution

Renal disorder

Epilepsy

Children


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Ciprofloxacin .....

ADVERSE EFFECT

Nausea vomiting Headache

Abdominal discomfort

Inhibiting metabolism of theophyllline, warfarin

&anticoagulant

Photosensitivity , Hyper pigmentation, Hypersensitivity

Insomnia


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Locally Delivered of Antibiotic

Limitation of systemic therapy, mouthrinse & irrigation have, promoted for

research for development of alternative

delivery system Requirement of treating periodontal disease

include

1. Controlled release of drug

2. Maintained localized concentration of

drug at infection site for optimum time

3. Minimal side effect


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Various Locally Delivered of

Antibiotic

ACTISITE (Tetracyclines)

ARESTIN (Minocycline) ATRIDIOX (Metronidazole )

PERIO CHIP (Chlor hexidine)

Elyzol (Metronidazole)


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Powered irrigation device

T t li


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Tetracycline Containing Fiber(ACTISITE ))

First local delivery product for antibiotic

Feature1. Ethylene or vinyl acetate copolymer fiber

2. Diameter 0.5 mm3. Containing Tetracycline

12.7 mg/ 9 inch

4. When packed into periodontal pocket, it is

well tolerated by oral tissue5. For 10 day it sustains tetracycline

concentration exceeding 1300 ug/ ml


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ACTISITE


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Actisite.......

EffectReduction in probing depth

Reduction in Bleeding on probing

Increase in clinical attachment level

Normally no staining on teeth

Reduction in plaque micro organism


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Sub Gingival Delivery Of Doxycline

ATRIDIOX

Atridox is gel system that incorporate theantibiotic Doxycycline (10%) in syringe able

gel system

It is a Biodegradable mixture Drug introduced Subgingivally

Applied with or without

Scaling or Root planning

Effect

Increase in clinical attachment level

Reduction in plaque micro organism

Probing depth reduction


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ATRIDIOX


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PERIO CHIP


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It is rounded on one end so easily inserted

Perio chip released Chlor hexidine and

maintain drug concentration in GCFmore than 1000 ug/ml for atr least 7 day

Bio degradable in 7 to 10 day

AdvantageReduction in probing depth

Reduction in Bleeding on probingIncrease in clinical attachment level

Normally no staining on teeth A


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antibiotics in perio

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