Efficacy+of+Systemic+Antibiotics

= =  Evidence-based on efficacy of systemic antibiotics for the treatment of periodontal disease. –Marcia There are guidelines for the use of antibiotic in periodontal therapy 1. The clinical diagnosis- The need may be due to refractory periodontitis, since periodontal diagnosis can change after initial treatment 2. Continuing disease activity, as measured by continuing attachment loss(pocket probing depth plus recession), purulent exudate, and continuing pockets <5, that bleeds on probing. 3. When used to treat periodontal disease, antibiotics are selected based on medical and dental status, current medications, microbial analysis, if performed. 4. Microbiologic plaque sampling may be performed according to the instructions of the reference laboratory. 5. Plaque sampling can be performed at the initial examination, root planning, reevaluation, or supportive periodontal therapy appointment. 6. Antibiotic have also been shown to have value in reducing the need for periodontal surgery in patients with chronic periodontal disease 7. Some studies have shown attachment gain with antibiotics given as monotherapy. (i.e., as stand-alone treatment without scaling and root planning or surgery). Newman, M. G., Takei, H. H., Klokkevold, P. R., Carranza, F. A. (2006). Carranza’s clinical Periodontology. St.Louis, Missouri: Saunders Elsevier
 * Efficacy of Systemic Antibiotic **

Reina: Systemic antibiotic treatment has become a powerful adjunct to the conventional, mechanical debridement for periodontal therapy. The concept of using antibiotics coincides with the substantial data indicating periodontal disease associated with specific pathogens. Five daunting problems have slowed the progress of ongoing research for the rational use of antibiotics: 1. Periodontal diseases are heterogeneous, e.g. chronic periodontitis vs. aggressive periodontitis vs. refractory periodontitis. 2. Clinical diagnoses are made based on clinical signs, not on molecular pathology. 3. The actual causal factor(s) have not been identified definitively. 4. Microbiological sampling and detection systems are expensive and not simple, making them difficult to achieve reproducible and accurate results. 5. There are many different antibiotic protocols, but few are well-designed and randomized controlled trials may not test the efficacy of the protocols well. There needs to be clearly established clinical outcomes that identify sustained improvements that are both statistically and clinically significant. When prescribing systemic antimicrobial agents to immunocompromised individuals with innate or acquired host defense deficiencies, the threat of secondary infection can be critical. The use of systemic antibiotics perhaps should be limited due to concerns of horizontal transmission of antibiotic resistance and the rise of resistant strains.

Ellen, R. P., & McCulloch, C. A. (1996, February). Evidence versus empiricism: Rational use of systemic antimicrobial agents for treatment of periodontitis. //Periodontology 2000//, //10//, 29-44.

The researchers stated that to their knowledge, this is the first study to determine the effect of scaling and root planning ± a sub-antimicrobial dose of doxycycline (in this case, they used 20 mg of Periostat twice a day or an identical-appearing placebo) in patients with both chronic periodontitis and coronary artery disease. The combination therapy produced statistically significant benefits in both local periodontal disease (in gingival index and pocket depth) and systemic biomarkers (high-density lipoprotein cholesterol and apolipoprotein-A). However, it was not clear if the sub-antimicrobial dose of doxycycline reduces the risk for cardiac events after combination therapy and whether these effects were due to direct effects on coronary artery disease or indirect effects resulting from improved periodontal health.

Tuter, G., Kurtis, B., Serdar, M., Aykan, T., Okyay, K., Yucel, A., et al. (2007, August). Effects of scaling and root planning and sub-antimicrobial dose doxycycline on oral and systemic biomarkers of disease in patients with both chronic periodontitis and coronary artery disease. //Journal of Clinical Periodontology//, //34//(8), 673-681.

Lia: The efficacy of systemic antibiotics in periodontal disease is difficult to interpret because of open-study designs, small sample size, short-term evaluation periods, clinically different patient groups, undetermined periodontitis disease activity, unknown baseline microbiota, varying antimicrobial regimens, and insufficient supragingival plaque control(Slots & Rams, 1990). Severe periodontal infections are a threat to oral and systemic health, so the use of antibiotics as an adjuct to instrumentation is acceptable in selected patients. There is a risk of the pt developing antibiotic resistance so this must be also considered. The goal of using antibiotics is to support mechanical therapy and aid the pt's host defenses by killing subgingival pathogens that are left behind following mechanical therapy. Microbiological testing through culturing the diseased site is indicated to know which bacterial pathogen is involved so the correct antibiotics can be prescribed and used.

Slots, J., Members of the 2003-2004 Research, Science and Therapy Committee. (2004, November).Systemic Antibiotics in Periodontics, J Periodontol, 75(11),1553-65.

Diem: Systemic antibiotic is used to treat chronic periodontal diseases that not response well to conventional SRP. The advantages of systemic delivery antibiotics are inexpensive and less time consumed. Because periodontal infections may contain numerous different bacteria, a single systemic antibiotic drug may not be effective. The most effective way of using systemic antibiotic is to combine more than one antibiotic drugs together. A controlled clinical trial indicated that the average probing depth reduction was 0.95 mm after scaling and root planning and SDD and 0.69 mm after root planning alone for the pocket depth from 4-6mm. The average probing depth reduction was 1.68 mm following scaling and root planning plus SDD and 1.20 mm following root planning alone for the pocket depth greater than 7mm. However, systemic antibiotics are not a substitute for professional root planning and appropriate treatment which are considered to minimize bacterial accumulation and facilitate proper personal hygiene (Greenstein, 2000). Greenstein, G. (2000). Nonsurgical periodontal therapy in 2000. //The Journal of American Dental Association, 131//, 1580-1592.

Metronidazole is an antifungal drug, but it’s also effective in treating P. gingivalis and P. intermedia. According to a Brazilian Oral Research, metronidazole is effective in plaque reduction and gingivitis, but unsure on periodontitis because the result was not concluded. Carranza stated further that Metronidazole can affect on A. a if combining with other antibiotics. Metronidazole has been treated NUG successfully, gingivitis, and periodontitis. The most common regimen is 250mg three times a day for a week. When Metronidazole is combined with amoxicillin, it is an effective drug to treat refractory periodontitis. Metronidazole is contraindicated with patients who undergo anticoagulant because it can inhibit warfarin metabolism. Newman, M., Takei, H., Klokkevold, P., & Carranza, F. (2006). Chemotherapeutic agents. In J. Pendill & J. Dedeke (Eds.). //Carranza’s Clinical Periodontaology// (pp.803-304). PA: Elsevier. Vergani, s., Silva V., Vinholis A., & Marcanotio R. (2004). Systemic use of metronidazole in treatment of chronic periodontal disease: A pilot study using clinical, microbiological, and enzymatic evaluation. The Brazilian Oral Research. Retrieved March 8, 2009, from []

Jackie

Systemic antibiotics should be adjunctive to adequate mechanical debridement, because there is not enough evidence to support their use to treat periodontal disease. Evidence shows that it should start on the day of debridement completion, and debridement should be completed I a short time. Herrera, D., Alonso, B., Leon, R., & Sanz, M. (2008). Antimicrobial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm. //Journal of Clinical// Periodontology, (35), 45-46. The use of both local and systemic antibiotics management to treat periodontal disease but their use has mainly empirical ground. The abuse of systemic antibiotics is attributed to the global emergence of antibiotic resistance organisms. It should only be use as an adjuntive to the treatment of periodontal disease on the patients who do not respond to adequate mechanical treatment alone. The systemic antibiotics attack the microorganism that evaded mechanical scaling, focal infection, or in localized recurrent disease. Antimicrobials enhance the effect of mechanical scaling on aggressive periodontitis, in patients with generalized systemic disease that may affect host resistance. Mombelli, A., & Samaranayake, L. P. (2004). Topical and systemic antibiotics in the management of periodontal diseases. //International Dentistry Journal, 54 (1)//, 3-14.

Systemic antibiotics used as adjunctive therapy to mechanical debridement has been researched and shown to improve certain types of periodontitis. The Academy Report says that the use of systemic antibiotics in certain patients with severe periodontitis is ethically acceptable. It has been shown to decrease the number of subgingival pathogens. Most of these pathogens that remain after instrumentation are imbedded in the tissue, so the antibiotics can kill the bacteria. However, it should only be used to support mechanical treatment. It also states that antibiotics can be given to patients that do not respond to phase I therapy. There is inconclusive evidence to show any benefit from systemic antibiotics alone without scaling and root planning. Periodontal pathogens are not the only factor involved in periodontal disease. How can one gain any attachment if the calculus and bacterial plaque, which is the etiological factor, is not removed? There have been some studies that show there may be a risk in developing a resistance to the antibiotics. Haphazard and random use of systemic antibiotics has been the leading factor in the resistance strains emerging. It is so important for the doctor to carefully choose what patients and with what periodontal conditions should be given systemic antibiotics. A microbial analysis is helpful in determining what antibiotic should be chosen depending on the type of pathogen. A study done in 2007, stated that amoxicillin and metronidazole was shown to significantly increase the clinical and microbial results, as well as, lower the patient’s plaque score. However, the study also stated that there needs to be more research done with larger study populations to determine the true efficacy.

Herrera, D., Alonso, B., Leon, R., Roldan, S., and Sanz, M. (2008). Antimicrobial therapy in periodontitis: The use of systemic antimicrobials against the subgingival biofilm. Journal of Clinical Periodontology, 35(8), 45-66. Newman, M. G., Takei, H. H., Klokkevold, P. R., and Carranza, F. A. (2006). Carranza’s Clinical Periodontology, 10th ed. Missouri: Saunders Elsevier. Slots, J. (2004). Systemic antibiotics in periodontics. Journal of Periodontology, 75(11), 1555-1564.

Brein In the research I read It stated that when used in conjunction with scaling and root planning systemic antibiotics can help to lower the amounts of bacteria associated with periodontal disease. one study stated that scaling and root planning periodontal therapy along with systemic antibiotics can rapidly lower the amount of microbes in the subgingival environment during healing, but has a minor effect on the elimination of these target microbes following therapy. Another study testing the effects of systemic antibiotics on tooth loss associated with periodontal disease found that with longer courses of tetracycline there was a reduction in tooth loss among patients receiving periodontal care. When penicillin was used in patients with more severer perio disease there was also a reduction in tooth loss. These study also stated that longer studies are needed to determine the true effects. With the use of these antibiotics improvements have been seen in periodontally involved patients, but what are the long term effects on these patients when these antibiotics are being used on a regular bases?

Buchmann, R. (2004). Short-Time Effects of Systemic Antibiotics in Periodontal Disease Therapy.

Dent, J. (2008). Systemic Antibiotics and tooth loss in Periodontal Disease.


 * Efficacy of Systemic Antibiotics in Periodontal Disease - Maria**

For most patients, routine dental cleanings, along with meticulous home oral hygiene, will prevent the loss of alveolar bone. However some patients continue to experience periodontal destruction despite these efforts. This is when the use of systemic antibiotics as an adjunct to periodontal therapy is considered. According to the American Academy of Periodontology the following conditions warrant the use of systemic antibiotics:

Juvenile Periodontitis

The bacteria, Actinobacillus actinomycetemcomitans (A.a), is the primary bacteria associated with this disease. Slots et al. (2004) showed that antibiotics as an adjunct to debridement provide more favorable long-term results for patients with juvenile periodontitis. Doxycycline, 100mg once a day for 21 days is effective in treating this condition

Necrotizing Ulcerative Periodontitis

Management of this condition is: 1) debridement to remove plaque and debris 2) prescription of chlorhexedine 3) prescription of Flagyl (metronidazole) 200mg, three times a day for seven days 4) review after 3-7 days to begin periodontal therapy According to Beikler et al. (2004), the prescription of an antibiotic reduces the pain associated with NUP more quickly than debridement alone.

Refractory Periodontitis

Some patients continue to show loss of attachment despite routine SRP treatment. In these situations, the use of antibiotics as an adjunct to SRP is indicated. According to Slots (2004) a two-week course of doxycyline (100 mg, once a day), along with surgical or non-surgical debridement, can cease the disease process. However the AAP recommends a combined regimen of amoxicillin (250 mg three times a day) and metronidazole (200 mg, twice daily) for seven days. Combining these antibiotics allows for a synergistic effect to take place.

Chronic Periodontitis

According to the AAP, chronic periodontitis should respond in a favorable way to non-surgical root debridement and proper home oral hygiene. If a patient continues to experience alveolar bone loss despite this approach, then periodontal flap surgery is indicated. Antibiotics are not recommended for patients with chronic periodontitis. This is due to the development of antibiotic resistance or allergic reaction to antibiotics.

American Academy of Periodontology. (2004). Systemic antibiotics for periodontics. Journal of Periodontology. 75(3), 1553-1565.

Beikler, T., Prior, K., Ehmke, B. & Flemming, T. (2004). Specific antibiotics in the treatment of periodontitis—A proposed strategy. Journal of Periodontology, 75(4), 169-175.

Slots, J. (2004). Systemic antibiotics for the treatment of periodontics. Journal of Periodontology, 75(1), 868-873.

Systemtic Antibiotics and Periodontal Treatment. Retrieved March 7, 2008, from http://www.adelaide. edu.au/spdent/dperu/cpep/systemic.htm


 * Efficacy of Systemic Antibiotics in Periodontal Disease - Natalie**

Systemic antibiotics have been used as an adjunct therapy for periodontal disease and are most often used in aggressive periodontitis and ANUP or when conventional therapies have been ineffective. This retrospective cohort study had over 12,000 participants with destructive periodontal disease who used systemic antibiotics for 1-13 days, 14-21 days or in some cases over 21 days(Cunha-Cruz, et al, 2008). The findings indicated that the use of systemic antibiotics did not result in less tooth loss among the individuals. In this study, a variety of subgroup were also analyzed and it was concluded that the use of systemic antibiotics in those individual with periodontal disease was “consistent with these overall null findings” except in the following circumstances: -“Longer courses of tetracyclines were associated with reduced tooth loss among persons receiving periodontal care, -Penicillin was associated with reduced tooth loss among persons with more severe disease” (Cunha-Cruz, et al, 2008). It appears that the type of systemic antibiotic as well as the duration of use would influence the effectiveness of the adjunct therapy.

Another study conducted by Dastoor, et al (2007), tested 30 smokers with 4-6 CAL. The control group received perio surgery as well as azithromycin therapy. The findings of this pilot study concluded that in heavy smokers, adjunct systemic azithromycin in combination with pocket reduction surgery did not statistically “enhance PD reduction or CAL gain”(Dastoor, et al. 2007). On the other hand, systemic administration of azithromycin did contribute to more “rapid wound healing, less short-term gingival inflammation, and sustained reductions of periopathogenic bacteria (Dastoor, et al. 2007).” The authors also concluded that more research needs to be conducted to help determine the clinical effects of systemic antibiotics as an adjunct therapy.

Cunha-Cruz, J., Hujoel, P., Maupome, G., & Saver B. (2008) Systemic Antibiotics and Tooth Loss in Periodontal Disease. Journal of Dental Research. 87:871-876.

Sarosh F. Dastoor, Suncica Travan, Rodrigo F. Neiva, Lindsay A. Rayburn, William V. Giannobile, & Hom-Lay Wang. (2007). Effect of adjunctive systemic azithromycin with periodontal surgery in the treatment of chronic periodontitis in smokers: a pilot study. Journal of Periodontology. 78(10): 1887–1896.


 * __Who Benefits the Most from Systemic Antibiotics for Periodontal Therapy? - Ferris__**

The fact that periodontal disease is caused by certain pathogenic bacteria has prompted studies on beneficial use of systemic antibiotics. The people that appear to gain the best results from this therapy are those that have continued to demonstrate bone loss even after periodontal SRP with maintenance has be used as well as people with ANUG. The most common antibiotics prescribed are metronidazole (Flagyl) for ANUG or doxycycline to treat disease caused by A.a. Some reports have been unable to show significant decrease in tooth loss in those taking these antibiotics but it is known to help clear up the infection caused by these bacteria. Patient's being treated for chronic periodontitis should not be prescribed antibiotics because the problem usually responds to SRP and maintenance alone as long as patients are compliant.

Cunha-Cruz, J., Hujoel, P., Maupome, G. & Saver, B. (2008). Systemic antibiotics and tooth loss in periodontal disease. Journal of Dental Research, 89 (9), 871-876.

Systemic antiobiotics and periodontal treatment. Retreived March 6, 2009 from http://www.adelaide.edu.au/spdent/dperu/cpep/systemic.htm systemic antibiotics Jennifer One study revealed that the systemic use of metronidazole (also used in the systemic treatment of NUP) did not have any effect in women with chronic perio after scaling and root planning of course. Which proves many of your points. These people in the studies did not have bacteria (I am thinking the amount or the more aggressive type ) in which needed systemic antibiotics. most likely because majority of the bacteria was removed during scaling and root planning. However I found another article which contradicts the first, and stated that the effects of the antibiotic had outstanding effect. I think this is when we put into play the type of pt who needs this antibiotic. I also found an interesting fact that metronidazole kills anaerobic bacteria not facultative, which makes it perfect in treatment of periodontal disease.

Alonso, V., Barbosa, S., Helena, V., Chierci, M. http://biblioteca.universia.net/html_bura/ficha/params/id/648846.html Systemic use of metronidazole in the treatment of chronic periodontitis: a pilot study using clinical, microbiologic and enzymatic evaluation.

Antimicrobial agents in Periodontal therapy. http://www.dent.umich.edu/research/loeschelabs/eduantimicrobial.html

Noo: As we all know that patients likely to benefit from antibiotics are those with limited response to conventional mechanical treatment. They are patients suffering from acute periodontal infections or aggressive periodontitis an those who are medically compromised. Systemic antibiotics can reach microorganisms that are inaccessible to scaling instruments or local antibiotic therapy. The main approaches to systemic antibiotic therapy are based on monotherapy, although combinations of antibiotics are becoming common. The most frequently used antibiotics are metronidazol, tetrayclines, clindamycin, ciplofloxacin and amoxicillin (Cunna and Jaker). In smokers (Dastoor et al.), the study showed Azithromicin is recommended. When deciding whether to use curative systemic antibiotic therapy, however, it is important to consider both benefits and undesirable effects. In smoker, patient compliance needs to be stressed. Dastoor, S., Travan, S., Rodrigo, N., Rayburn, L., Giannobile, W., and Wang, H. (2007). Effect of adjunctive systemic Azithromycin with periodontal surgery in the treatment of chronic periodontitis in smokers. //Journal of Periodontology//. //78(10):// 1887-1896. Cunna V. and Jaker B.(2006). Systemic antibiotics and the improvement of periodontal parameters in aggressive periodontitis. //Journal of Periodontology 56( 13)// 127-129

Systemic Antibiotics-Tawnya

Systemic antibiotics can be used in conjunction with scaling and root planning with patients with moderate to refractory periodontitis and ANUP. While studies have shown a decrease in Aa. P. gingivalis and P. intermedia which are some of the bacteria present with periodontal disease there was very little change (statistically insignificant) in pocket depth, clinical attachment level, PI or BOP when comparing the placebo to 500mg amoxicillin with 250mg metronidazole. Patients taking the antibiotic showed little pocket decrease of less then 1/2mm more then the patients taking the placebo. A second study evaluated clarithromycin and found increased levels in the gingival tissues at the diseased and inflamed sites compared with the healthy sites, appearing as if the clarithromycin was distributed there more. However this study did not evaluate the effects of clarithromycin on inflammation as this study was merely looking at the presence of the drug and was not conducted for more then 3 days, so more research needs to be done to evaluate the impact clarithromycin has to inflamed tissue. Little side effects were noted with clarithromycin or amoxicillin with metronidazole. A small group of patients experienced GI upset and also could have experienced herpetic and allergic reactions.

Moeintaghavi, A., Talebi, M., Haerian, A., Zandi, H., Taghighpour, S., Fallahzadeh, H., et. al. (2007). Adjunctive effects of systemic amoxicillin and metronidazole with scaling and root planning: a randomized, placebo controlled clinical trial. Journal of Contemporary Dental Practice. 8 (5) 51-59.

Burrell, R. and Walters, J. (2008). Distribution of systemic clarithromycin to gingival. Journal of Periodontology. 79 (9) 1712-1718.

Dorinda Systemic delivery of antibiotics should be used when mechanical treatment is not effective. It should always be used as an adjunct to therapy not as the primary therapy treatment. Systemic therapy has shown that it has beneficial results when used over a long period of time. However, there are disadvantage which include bacterial resistance and allergies to the antibiotic (penicillin).

Britney

In the research that I did on the efficacy of systemic antibiotics on the treatment of periodontal disease I found that along with SRP systemic antibiotics can play a role in helping to reduce periodontal pockets. There is always the risk however, that the systemic antibiotics can be used too much or in the wrong instance. If this happens then resistant strains of bacteria can develop. I think that to make sure that the antibiotics are used properly; they need to be used on a case by case basis and used with caution. The research talks about making sure that you are only using the antibiotics when necessary such as when there are instances of NUP or when a patient is not responding to treatment for whatever reason. I also think that culturing of bacteria in these patients can also help to make sure that the right antibiotics are used and that they are only used when absolutely needed. Hopefully with the advances in technology, soon enough it will be easier/less expensive to test/culture bacteria from periodontal pockets to find out what is causing periodontal disease in specific patients so that more personalized and effective therapy can be developed for that patient. Overall I think that systemic antibiotics can be a big help in the fight against periodontal disease as long as they are used with caution and are utilized only when necessary.

References:

Greenstein, G. (2000). Nonsurgical periodontal therapy in 2000: a literature review. Journal of the American Dental Association. 131(11), 1580-1592.

Moeintaghavi, A., Talebi-ardakani, M.R., Haerian-ardakani, A., Zandi, H., Taghipour, S., Fallahzadeh, H., et al. (2007). Adjunctive effects of systemic amoxicillin and metronidazole with scaling and root planing: a randomized, placebo controlled clinical trial. Journal of Contemporary Dental Practice. 8(5), 51-59.

Ceri: In a study that I researched it compared the use of systemic antibiotics in patients that smoke and do not smoke. In this study, the results showed that the smokers group showed continuing attachment loss and less reduction in BOP results. But when the research was completed they found that in general patients that smoke had a diminished response to all treatment. The only treatment that helped improve probing depths in the smoking patients was metronidazole. Definitely the treatment of periodontal disease in regards to either type of patient, should be viewed case by case. Most of the results showed that there as greater results in the non smoking patients. The study stated that essential risk factors should be considered in estimating the treatments effects. As I said it is all taken on a case by case basis.

Pahkla. E, Koppal. T, Naaber, P, Saag, M and Loivukene, K. (2006). Stomatologica, Baltic Dental and Maxillofacial Journal. 8(4). 116-121.

The AAP paper states that when prescribing antibiotics for periodontitis many things need to be taken into consideration. There are many different criteria to be researched before a patient should take the antibiotic. First of all the correct patient should be chosen. The patient should exhibit a continuing loss of periodontal attachment, also patients who suffer from aggressive periodontitis, or with medical conditions that predispose the patient to periodontal disease. Another patient that can benefit from systemic antibiotic therapy may be those that suffer from acute or severe periodontal infections.

There are definitely advantages and disadvantages to using systemic antibiotics. The advantages include administering the drug to multiple sites where disease is present and active. There is also the possibility of eliminating entirely all pathogens from the mouth and may even reduce the risk of future disease progression.

The disadvantages include possibly having an increased risk of adverse drug reactions, resistance to certain antibiotics may also occur, also there may be some uncertain patient compliance.

In order to determine which antibiotics work the best for the different types of patients a microbial analysis may be needed. This is done because it is recommended that the dentist know the type of subgingival microbiota that are present in the mouth of the patient. This is done to avoid prescribing antibiotics against pathogens that are resistant to treatment. When a prescription is made that is not correct overgrowth of pathogens may occur, and there could be a poor clinical response in the patient.

Slots, J. (November 2004). Systemic Antibiotics in Periodontics. Journal of Periodontology. 75(11). 1553-1565.

Another paper states how systemic antibiotic use compares to that of topical use. This research stated how systemic antibiotics reach the pathogens of periodontal disease through the serum in the pockets, furcation areas, within gingival epithelial tissue and within connective tissue. In regards to aggressive periodontitis this is important because the diffusion of antibiotics into connective tissue and epithelial tissue helps to be more effective against A. actinomycetemcomitams. A. a. tends to invade the epithelial and connective tissue and topical antimicrobials are not as effective at reaching high concentrations to really decrease the levels of the bacteria. Systemic antibiotics also prevent the periodontal pathogens from colonizing in other periodontal sites.

According to this research one advantage of topical agents is that they are able to achieve high concentrations in gingival crevicular fluid.

Seiler, J. S and Herold, R. W. (March-April 2005). The use of systemic antibiotics in the treatment of aggressive periodontal disease. General Dentistry. 155-159.


 * Priscilla Garcia**

Periodontitis is a disease that causes destruction of the PDL and alveolar bone. The etiology of this disease are the bacteria such as, A.actinomycetemcomitans and P. gingivalis. Systemic antibiotics have been prescribed to patients that don’t respond to the conventional therapy. Patients for this type of therapy include Refractory periodontitis, aggressive perio, or acute necrotizing periodontitis (Seiler, 2005). The advantage of systemic therapy is the antibiotics can reach the base of deep pockets and also within the epithelial and connective tissues (systemic antibiotics in periodontics, 1996). Decreasing the amount of pathogens present in the mouth can decrease the risk of re-occurrence. One major disadvantage to this therapy includes antibiotic resistance. Systemic antibiotics are used as an adjunct with conventional therapy and should be used conservatively.

Seiler, J., Herold, R.W. (2005). The use of systemic antibiotics in the treatment of aggressive periodontal disease. DART. 155-159.

Systemic antibiotics in periodontics. (1996). Journal of Periodontology, (67) 831-838.

Melody: Systemic antibiotics for the treatment of periodontal disease is being used today but from what I read it should only be prescribed to patients with severe periodontal infections that may be affecting their systemic health. Due to over prescribing antibiotics bacteria is becoming resistant to the antibiotics so we should be prescribing restrictively and conservatively.

Cunha-Cruz J., Hujoel P., Maupome G., Saver B. Antibiotics and tooth loss in Periodontal Disease. Journal of Dental Research 2008; 87 871-876.

http://ww.fda.gov/fdac/features/2002/302.gums.html

Drina: Systemic antibiotics, in the treatment of periodontal disease, doesn’t seem to be beneficial. Surgical treatment alone improved clinical parameters but in conjunction with Axithromycin there was no enhanced improvement. The only thing it did do was help with the healing and reducing inflammation. Tetracyclines and metronidazole were not associated with lower rates of tooth loss. They were recommended for adjunctive periodontal therapy because they reduced the need for surgery or extractions. Macrolides and penicillin were not associated with tooth loss, and clindamycin was associated with higher tooth loss incidences..

References: Cunha-Cruz, H., Hujoel, P., Maupome, G., & Saver, B. (2008, September). Systemic antibiotics and tooth loss in periodontal disease. Journal of Dental Research 87(9): 871-876. Dastoor, S., Travan, S., Neiva, R., Rayburn, L., Giannobile, W., & Wang, H. (2007, October). Effect of adjunctive systemic Azithromycin with periodontal surgery in the treatment of chronic periodontitis in smokers: A pilot study. Journal of Periodontology 78(10): 1887-1897.

The use of antibiotics for the treatment of periodontal disease highly recommended as an adjunctive therapy to SRP. Antibiotics alone are not effective in the treatment of periodontal disease. The question is, what is more beneficial for the patient? Systemic antibiotic therapy or local delivery antibiotic therapy? Personally, I think it would depend on the patient. Are they on any other medications? This would definitely have an impact on which route to take. Medications can contraindicate other medications and have adverse reactions. In my research I found one study that showed there was no significant difference in either routes of administration with tetracycline, another words, they were both effective. Another study showed that amoxicillin was more efficacious than CHX as an adjunctive therapy. I believe this issue will be patient specific and medication specific. What microorganisms are we targeting, specifically, and does the medication target that species specifically? Would we need to do a microbial analysis on patients to be optimal in our treatment with antibiotic therapy? Reference: Purucker, P., Mertes, H., Goodson, J.M., and Bernimoulin, J.P. (2001). Local versus systemic adjunctive antibiotic therapy in 28 patients with generalized aggressive periodontitis. //Journal of Periodontology, 72//(9): 1241-1245. Kaner, D., Bernimoulin, J.P., Hopfenmuller, W., Kleber, B.M., and Friedmann, A. (2007). Controlled-delivery chlorhexidine chip versus amoxicillin/metronidazole as adjunctive antimicrobial therapy for generalized aggressive periodontitis: a randomized controlled clinical trial. //Journal of Clinical Periodontology, 34//(10): 880-891. Mombelli, A., and Samaranayake, L.P. (2004). Topical and systemic antibiotics in the management of periodontal disease. //International//
 * Efficacy of Systemic Antibiotics - St**