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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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