9.+Efficacy+of+Systemic+Antibiotics



Efficacy of Systemic Antibiotics Guerrero, A., Griffiths, G. S., Nibali, L., Suvan, J., Moles, D. R., Laurell, L., Tonetti, M. S. (2005). Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive periodontitis: a randomized placebo-controlled clinical trial. //Journal of Clinical Periodontology//, 32(10), 1096-1007.

The article was examining the efficacy of systemic antibiotic on generalized aggressive periodontitis. Research showed that use of adjunctive systemic antibiotics for 7 days in individuals with generalized aggressive periodontitis significantly improved the clinical outcomes of nonsurgical periodontal therapy. Y. B #23

Buchmann, R., Conrads, G., & Sculean, A. (2010). Short-term effects of systemic antibiotics during periodontal healing.//Quintessence International//, //41//(4), 303-312. Retrieved April 20, 2012, from [|http://ezproxy.mvc.edu:2074/ehost/detail?vid=4&hid=123&sid=b389c6b6-d049-47d7-9fe9-bda206517f23%40sessionmgr114&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=ddh&AN=48791270]

My article talked about the main reason for systemic use of antibiotics on perio is to reduce or eliminate pathogens that exist subgingivally. Studies have shown that the use of metronidazole and amoxicillin can reduce the clinical outcomes of probing depths and change the level of clinical attachment and reduce the risk for additional clinical attachment loss. However, the article did mention that the miroflora associated with periodontal disease varies from patient to patient and the response to an antibiotic can be expected to vary. Carranza talks about Host Modulation Therapy: theapy that is aimed to reduce or eliminate pathogens that alter chemical of physical enviroment. There purpose is to restore the balance of prioninflammatory or destructive mediators by a counter balance of antiinflammatory or protective mediators. (So basically make more good guys to kill the bad guys).Carranza also stated that the use of chemotherapeutic agents and drugs can be used to reduce excessive levels of enzymes, cytokines and prostaniods as well as to modulate osteoclast and osteoblast function. Also, modulatory agents can increase the levels of a persons own protective mediators which can provide extended benifits for other inflammatory disorders. CA20

Heitz-Mayfield, L. A. (2009). Systemic antibiotics in periodontal therapy. //Australian Dental Journal//, //54//S96-S101. doi:10.1111/j.1834-7819.2009.01147.x My article discussed the adjunct use of sytemic antibiotics in periodontal therpy. The article explains that the antibiotics aim at targeting specifc pathogenic bacteria within the periodontal biofilm. They also mention that the rationale for use of systemic antimicrobials is to further reduce the bacterial load enabling resolution of the inflammation in the periodontal pocket. Carranza explains that there is no specific antibiotic for periodontal treatment because you must first identify the pathogens involved because it can be different in every person. Also it depends on what type of periodontal disease the patients has, for instance aggressive or chronic. Carranza explains some implications for using antibiotics, which include continuing disease, such as a patient having continued attachment loss. Also Carranza explains it is based on the patient’s medical and dental status and can reduce the need for periodontal surgery. Amber Starnes 36

Alonso, B., Herrera, D., León, R., Roldán, S., & Sanz, M. (2008). Antimicrobial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm. //Journal of Clinical Periodontology, 35 (8), pp. 45-66.// Systemic antimicrobials should only be used as an adjunct to mechanical debridement. There use should be restricted to certain patients and conditions. Subantimicrobial dose doxycycline (SDD) is the only FDA approved systemically administered Host Modulatory therapy for periodontitis. When using SDD over a 3 month time period it has shown beneficial results when combined with scaling and root planing. SDD inhibits the breakdown of connective tissue and has shown increases in attachment levels. Velinda Davis #24

Serino, G. G., Rosling, B. B., Ramberg, P. P., Hellstrom, M. K., Socransky, S. S., & Lindhe, J. J. (2001).The effect of systemic antibiotics in the treatment of patients with recurrent periodontitis. //Journal Of Clinical Periodontology//, //28//(5), 411. Retrieved from http://ezproxy.mvc.edu:2074/ehost/pdfviewer/pdfviewer?sid=9626cdf4-ad3a-401c-bc87-5e2ac9cf58ce%40sessionmgr13&vid=12&hid=12 The Big idea of my article is that the use of mechanical and chemical treatment that consist of SRP and systemic antibiotic use are more effective in the treatment of periodontitis. This combinations of SRP and the use of amoxicillin and metranidozole demonstrated that subjects with advanced and recurrent periodontitis established periodontal conditions that can be maintained by traditional supportive treatment phase. Monica Gutierrez#27

Systemic Antibiotics as Adjuncts to Scaling and Root Planing. (2010). //Biological Therapies in Dentistry, 26(3).// 10 My article was a study designed to show the short-term effects of nonsurgical therapy on the subgingival microbiota in aggressive and chronic periodontal disease and to test the hypothesis that the time course of subgingival recolonization during healing after administration of systemic antibiotics as adjuncts to periodontal therapy differs from that of mechanical debridement alone. The researchers observed subjects with chronic and aggressive **periodontitis**. The study demonstrated that scaling & root planning alone resulted in the early elimination and suppression of bacteria right after completing active treatment, while scaling & root planning combined with **systemic** **antibiotics** were found to accelerate the suppression of periodontal microflora and also having greatest reduction in probing depths and increased CAL; thus systemic antibiotics may also accelerate the healing process. The authors concluded that elimination of targeted pathogens cannot be achieved and the benefit of using antibiotics after 3 weeks posttreatment is unclear. Carranza states the importance of establishing the causative microorganisms via antibiotic sensitivity test (possibly oral DNA sampling to identify which antibiotic will be most effective against particular bacteria). Carranza also states that there is risk for developing bacterial resistance, therefore indiscriminate use of antibiotics has propelled guidelines for their use in dentistry. It is critical to integrate the patient medical health history (including medications that may have a contraindication for combined use of antibiotic therapy), history of oral disease, clinical signs and symptoms and radiographic results to determine course of periodontal therapy before prescribing an antibiotic, as well as eliminating the etiologic factors through mechanical debridement. Arlene C. Sides #35 -- Slots, J., & Ting, M. (2002). Systemic antibiotics in the treatment of periodontal disease. //Periodontology 2000//, //28//(1), 106-176

According to Carranza recent therapeutic efforts focuses on altering the patients host response, because when the amount of bacteria was minimized, the host response became more effective. My article and Carranza both agree that the bacteria contributing to the periodontal disease is never completely eliminated with scaling and root planing alone. According to my article it is best to prescribe antibiotics based on the findings of a microbial analysis so the antibiotics prescribed are for the specific bacteria which helps prevent antibiotic resistant bacteria.

Lauren #38

Bidault, P., Chandad, F., & Grenier, D. (2007). Risk of Bacterial Resistance Associated with Systemic Antibiotic Therapy in Periodontology. //Journal Of The Canadian Dental Association//, //73//(8), 721-725.

Carranza discusses the different types of systemic antibiotics used in periodontal therapy and the specific organisms that they are used against. It mentions how systemic antibiotics are indicated in certain settings where the host response is impaired at fighting off periodontal pathogens, such as in the case of NUG or NUP. The book also talks about how resistance and systemic interactions with other medications influence the effectiveness of systemic antibiotics, and my article goes on in more detail regarding the developement of resistance and how systemic antibiotics should not be used repeatedly for long periods of time. AH28

Shah, S., Qayyum, Z., Shah, S., Khan, S., & Pasha, F. (2011). PROPHYLACTIC USE OF ANTIBIOTICS TO PREVENT FLARE-UP IN ENDODONTIC TREATMENT. //Pakistan Oral & Dental Journal//, //31//(2), 427-431.

My article touched on two areas: researching how well systemic antibiotics are to reduce post operative flare up pain following root canal treatment, and how systemic antibiotics should be limited and reduced in the field of medicine due to the danger over use of systemic antibiotic has on creating antibiotic resistance. The study concluded that systemic antibiotics prior to root canal therapy was not effective at treating post operative pain following root canal treatment. The study also suggessted that the use of antibiotic treatment are overly prescribed to treat conditions in which systemic antibiotics are not effective at treating. The study suggested that studies need to be conducted on the use of systemic antibiotics to treat certain conditions in order to determine if the use of an antibiotic is effective or necessary. The over use of systemic antibiotics and antibiotic resistance should always be considered when prescribing antibiotics. It's comes down to do the pro's out weight the cons.

Carranza discussed the different uses for using systemic antibiotics in the field on dentistry. Carranza notes that bacteria is primarily responsible for oral health diseases and can be used to decrease the bacteria circulating the the oral cavity and help improve the host response to treat certain conditions such as NUG and NUP.

Newman, M.G., Takei, H.H.,Klokkevold,P.R.,&Carranza,F.A. (2006). Carranza's Clinical Periodontology (10th ed.).St. Louis

-Kimberley Robinson

Fellman, M. (2010). Pharmacology and Periodontal Disease: Implications and Future Options. Journal Of The California Dental Hygienists’ Association, 25(2), 9-25. From my reading in Carranza and my article, they both mention the importance being able to identify what patients would most benefit from the use systemic antibiotics. As of now there is no ideal antibiotic for the treatment of periodontal disease, but they can be effective in helping eliminate periodontal pockets in conjunction to hand scaling. Most importantly, when considering using systemic antibiotics on patients, it is crucial that we identify any risk factors or contraindications such as resistance or allergies the patient may have toward the antibiotic. Other concerns to consider are patient willingness, compliance, and cost. ES33

Akincibay, H., Örsal, S. Ö., Şengün, D., & Tözüm, T. F. (2008). Systemic administration of doxycycline versus metronidazole plus amoxicillin in the treatment of localized aggressive periodontitis: A clinical and microbiologic study. //Quintessence International//, //39//(2), e33-e39. In this article, they did a study on the efficacy of doxycycline vs metronidazole and amoxicillin in the treatment of aggressive perio when treated systemically. In this study they had two groups who both had agressive perio with positive A. a. bacteria: The first group treated with doxycyline and the other treated with metronidazole plus amoxicillin over a 90 day period. Each groups were shown positive for A. a. and had scaling and root planing procedures completed at day one. after 10 days the results showed that both groups had no signs of A. a. After 90 days results showed a significant gain in CAL, decreased probing depths, improved plaque and gingival scores, and supression of A. a. for at least 3 months. Therfore, both doxycyline and metronidazole pluse amoxicillin are effective in the treatment of agressive periodontitis. Carranza states that an ideal antibiotic for the treatment of periodontal disease should be specific for the periodontal pathogens, but does not exist. A combination of antibiotics may be necessary and choosing the best antibitoic is based on the patient's clinical status, nature of colonizing bacteria, the risk of benefits, and if it may cause adverse reaction to the patient as well as cost. Natalie Baeza #22

Bidault, P., Chandad, F., & Grenier, D. (2007). Systemic Antibiotic Therapy in the Treatment of Periodontitis. //Journal//

 //Of The Canadian Dental// //Association //, //73//(6), 515-520.

My article described the advantages and disadvantages of using systemic antibiotics to treat periodontitis. One of the advantages was that systemic antibiotics are released through the serum, which allows it to reach the microorganisms that are not able to reached with scaling and root planing and locally placed antibiotics. Some of the disadvantages of using systemic antibiotics is the chance of developing fungal infections, resistant strands of bacteria, and allergic reactions. Carranza states that one of the most important things to consider when thinking about using systemic antibiotics is identifying the causative microorganism responsible for destruction. This process is a lot easier said than done and currently an ideal antibiotic for periodontitis does not exist. It is important for both the clinician and the patient to understand both the benefits and the risk of systemic antibiotic treatment before implementing a treatment plan. -Elina Sandoval #34

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Matarazzo, F., Figueiredo, L., Cruz, S., Faveri, M., & Feres, M. (2008). Clinical and microbiological benefits of systemic metronidazole and amoxicillin in the treatment of smokers with chronic periodontitis: a randomized placebo-controlled study. //Journal Of Clinical Periodontology//, //35//(10), 885-896. doi:10.1111/j.1600-051X.2008.01304.x

After reading the article and Carranza the “Big Idea” for systemic antibiotics is choosing the right systemic antibiotic for the specific etiologic microorganism. The perfect systemic antibiotic shold be specific for the pathogens present, allogenic and non toxic, have substanstivity, and not in general use of other diseases. At present this does not exist. The decision should be placed with the clinician and the patient. A Yanez 37

____________ Mombelli, A., Brochut, P., Plagnat, D., Casagni, F., & Giannopoulou, C. (2005). Enamel matrix proteins and systemic antibiotics as adjuncts to non-surgical periodontal treatment: clinical effects. //Journal Of Clinical Periodontology //, //32 //(3), 225-230. My articles big idea was to show that systemic antibiotics have an effect on pocket depths when used in combination with enamel matrix derivative. In Carranza the big idea is that systemic antibiotics are only effective if we can find the specific periodontal pathogen that the patient has and there are no ideal antibiotics at this time. SF 25