In vitro antibacterial activity of ofloxacin against periodontal disease-associated bacteria

Comparative Evaluation of L-PRF and Ofloxacin Incorporated L-PRF as an Adjunctive to SRP-A Split-Mouth Randomized Clinical Trial

Aim and Objectives

To compare and evaluate the clinical efficacy of "ofloxacin incorporated L-PRF" and "L-PRF alone" when used as an adjuvant to non-surgical periodontal therapy.

Materials and Methods

A split-mouth study was conducted in 50 patients diagnosed as chronic periodontitis with pocket depth ≥6 with at least one site in each quadrant. All patients underwent scaling and root planning. Test site received with ofloxacin incorporated L-PRF and control site received L-PRF alone. Clinical parameters pocket depth (PD), plaque index (PI), and gingival bleeding index (GBI) were recorded at baseline and 1 month after scaling and root planning.

Results

In total, 100 sites were treated (50 test group and 50 control group) with no uneventful healing effects. Statistically significant decreases in PD (P = .0001 for both test and control groups), PI (P = .001), GBI (P = .001 for both groups), between pre-treatment and 1 month post-treatment were noted in both test and control groups. For intergroup comparisons, there was a statistically significant difference in all clinical indices (P > .005).

Conclusion

Use of L-PRF with ofloxacin as an adjuvant to non-surgical periodontal therapy showed better improvements in clinical parameters.

Fluoroquinolones in the treatment of Actinobacillus actinomycetemcomitans-associated periodontitis

BACKGROUND

Periodontitis patients harboring Actinobacillus actinmycetemcomitans (Aa) are prime candidates for systemic antibiotic therapy. Besides tetracycline and the combination of metronidazole and amoxicillin the fluoroquinolones are also believed to have antibacterial activity against Aa. The aim of the present study was to evaluate systemic ofloxacin therapy as adjunct to flap surgery.

METHODS

Twenty-five adult periodontitis patients with subgingival detection of Aa were treated with 2x200 mg/d ofloxacin for 5 days as adjunct to open flap surgery (test). Another 10 patients received only flap surgery (control). Probing depth (PD) and clinical attachment level (CAL) was recorded and subgingival plaque samples were cultivated on TSBV agar for detection of Aa at baseline as well as 3 and 12 months following therapy.

RESULTS

At 3 and 12 months following therapy mean PD at monitored sites in the test group changed from 6.8 mm (+/-1.3) to 3.6 mm (+/-1.0), 3.8 mm (+/-1.1) and CAL from 7.5 mm (+/-1.4) to 5.4 mm (+/-1.4), 5.5 mm (+/-1.3). In the control group PD changed from 6.5 mm (+/-0.7) to 4.0 mm (+/-1.7), 4.1 mm (+/-1.6) and CAL from 7.5 mm (+/-1.0) to 6.3 mm (+/-1.7), 6.4 mm (+/-1.8). P was <0.05 for CAL between groups. Three and 12 months following adjunctive systemic ofloxacin therapy, Aa was suppressed below detectable levels in 22 of 22, test patients, whereas Aa could not be recovered in only 2 of the 10 controls. (P<0.0001).

CONCLUSIONS

Systemic ofloxacin as adjunct to open flap surgery is able to suppress A. actinomycetemcomitans below detectable level in patients harboring this organism at baseline.

Quantitative comparison of cytocidal effects of tetracyclines and fluoroquinolones on human periodontal ligament fibroblasts

The cytocidal effects of tetracyclines and fluoroquinolones on human periodontal ligament fibroblasts (Pel cells) were studied. Pel cells were treated for 24 h with tetracycline (TC), demeclocycline (DMC), minocycline (MINO), chlortetracycline (CTC), tosufloxacin (TFLX), enoxacin (ENX), sparfloxacin (SPFX), lomefloxacin (LFLX) or ofloxacin (OFLX), and allowed to form colonies. The cytocidal effects of the antibacterial agents, as determined by a decrease in colony-forming efficiency, increased as the dose increased. However, CTC was an exception. As a quantitative measure of the cytocidal effect, LD50, the concentration which results in a 50% decrease in colony-forming efficiency relative to control cells, was extrapolated from the dose-response curves. The rank-order of cytocidal effects (LD50) was DMC [symbol: see text] MINO [symbol: see text] TC >> CTC. DMC, MINO and TC were at least 5.6-6.6 times more cytocidal than CTC. The cytocidal effects of the fluoroquinolones were in the following order: TFLX > ENX > SPFX > LFLX > OFLX. TFLX, ENX, SPFX and LFLX were 36.3, 11.4, 7.7 and 3.1 times more cytocidal than OFLX, respectively. Little cytocidal effect was observed when the cells were treated with either < or = 0.03 mM tetracyclines or < or = 0.01 mM fluoroquinolones. The results provide useful estimates concerning the relative toxicities against human periodontal ligament of antibacterial agents used to treat periodontitis.

Effects of a combination of an antibacterial agent (ofloxacin) and a collagenase inhibitor (FN-439) on the healing of rat periapical lesions

To investigate the effects of a combination of an antibacterial agent (ofloxacin) and a collagenase inhibitor (FN-439) in the root canal treatment of apical periodontitis, we studied the healing process of experimentally induced periapical lesions in rats by using immunohistochemical methods. With a topical application of a combination of ofloxacin and FN-439 following experimentally induced periapical lesions, both neutrophils and macrophages became significantly decreased in number, while active cementogenesis and extensive bone formation were seen in the periapical region. However, the use of ofloxacin alone also demonstrated a beneficial effect on periapical inflammation and healing. Therefore, it is suggested that ofloxacin is powerful against bacterial infection whether FN-439 is added. The only observed effect of a combination of ofloxacin and FN-439 is that it may more effectively inhibit osteoclastic bone resorption and activate the remodeling of the apical periodontal tissue if this combined medicament is used in a stage of active bone destruction characterized by high production of tissue collagenase.

In vitro activity of tetracyclines, macrolides, quinolones, clindamycin and metronidazole against periodontopathic bacteria

We re-evaluated several antibiotics including newer ones, for their in vitro killing activity, as well as their inhibitory activity, against clinical isolates of periodontopathic bacteria. Tetracyclines were active against Porphyromonas gingivalis, and were highly active against Prevotella intermedia, but demonstrated only a low killing activity against Actinobacillus actinomycetemcomitans. Rokitamycin, a new macrolide, and clindamycin were highly active against P. gingivalis and P. intermedia, but showed very weak killing activity against A. actinomycetemcomitans. Quinolones demonstrated excellent bactericidal activity against A. actinomycetemcomitans, and good inhibitory and bactericidal activity against P. gingivalis and P. intermedia. Metronidazole had an activity almost equivalent to quinolones against P. gingivalis and P. intermedia; but it was the least active against A. actinomycetemcomitans.

Topical chemotherapy in human periodontitis using a new controlled-release insert containing ofloxacin. I. Microbiological observation

The recognition that destructive periodontal diseases may be caused by specific microorganisms in periodontal pockets has led to an increased interest in and usage of antimicrobial agents in periodontal therapy. Recently, a new controlled-release insert containing ofloxacin, a synthetic antibiotic, has been developed. In this study, the controlled-release insert (PT-01) was microbiologically evaluated in combination with or without subgingival mechanical debridement. PT-01 was applied in the periodontal pockets of 27 patients with chronic periodontitis. Three sites with a deep probing pocket depth (greater than or equal to 5 mm) were randomly selected in different quadrants of each patient, and were assigned into three groups, i.e., PT-01 applied (T), placebo applied (P) and control sites (C). Periodontal treatments consisted of supragingival scaling with oral hygiene instruction for the first 2 weeks followed by root planing and subgingival scaling PT-01 was applied weekly on day 0 to 35, and the subgingival plaque samples from each site were collected on d 0, 14, 21 and 42. The dynamics of the subgingival microflora was investigated by dark field microscopy and by anaerobic and aerobic cultivation. In the supragingival scaling period, significant reduction in percentages of spirochetes and motile rods and significant increase of the percentage of coccoid cells were observed only at T sites. In addition, the total viable counts of bacteria, black-pigmented Bacteroides and Fusobacterium species were significantly reduced at T sites. After mechanical subgingival debridement, significant shifts in the proportion and reduction of the viable counts in the subgingival microflora were found at all sites.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro antimicrobial sensitivity of enteric rods and pseudomonads from advanced adult periodontitis

The prevalence and in vitro antimicrobial sensitivity of isolates of enteric rods and pseudomonads was examined in 844 adult periodontitis patients. These organisms were recovered from 13.5% of the study subjects. Ciprofloxacin exhibited the highest inhibitory activity of the 14 oral antimicrobial agents tested. Beta-lactam antibiotics were largely ineffective, and tetracycline failed to inhibit most Pseudomonas species. In vitro sensitivity data suggest that a subgingival microbiota comprising mainly streptococci would result from therapy that combined ciprofloxacin and metronidazole. Since streptococci may inhibit the growth of several putative periodontal pathogens, populations of "beneficial" streptococci in the periodontal pocket might constitute a very attractive therapeutic outcome. Controlled clinical studies are needed to clarify the possible role of ciprofloxacin in the treatment of destructive periodontitis.

Antibiotics in periodontal therapy: advantages and disadvantages

Antibiotic treatment of periodontitis aims at eradicating or controlling specific pathogens. Prime candidates for antibiotic therapy are patients with recently diagnosed active periodontitis or a history of recurrent disease who fail to stabilize following mechanical/surgical therapy. Since a variety of microbes with differing antimicrobial susceptibility profiles may cause periodontitis, selection of antimicrobial agents should be based on proper microbial diagnosis and sensitivity testing, as well as consideration of the patient's medical status. The risk of treating chemotherapeutically solely on the basis of clinical features, radiographic findings or a limited microbiological analysis, is failure to control the pathogens or overgrowth of new pathogens. A review of published papers reveals that appropriate systemic antibiotic therapy may enhance healing in patients with recent or high risk of periodontal breakdown. Systemic antibiotic therapy seems more predictable than topical administration in eradicating periodontal pathogens from deep periodontal pockets. Several promising antimicrobial agents for periodontitis treatment need testing in placebo-controlled, double-blind, randomized clinical trials.

Prevalence and antimicrobial susceptibility of Enterobacteriaceae, Pseudomonadaceae and Acinetobacter in human periodontitis

This study examined the occurrence of non-oral gram-negative facultatively anaerobic rods in advanced adult periodontitis. Speciation and in vitro antimicrobial susceptibility testing was performed using the MicroScan micromethod system. A total of 42 taxa of Enterobacteriaceae, Pseudomonadaceae and Acinetobacter were isolated from 427 of 3,050 (14.0%) patients. In 159 (5.2%) patients, these organisms comprised more than 5% of the cultivable subgingival microflora. Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Klebsiella oxytoca and Enterobacter agglomerans accounted for more than 50% of all strains isolated. Virtually all study strains demonstrated high in vitro susceptibility to ciprofloxacin, but exhibited variable susceptibility patterns to 18 other antimicrobial agents tested. In 3 "refractory" periodontitis patients heavily infected with enteric rods, systemic ciprofloxacin therapy (500 mg BiD for 10 days) led to resolution of the subgingival infections and improved clinical periodontal status. The present findings indicate that 5% of severe periodontitis lesions may harbor high levels of non-oral, gram-negative, facultatively anaerobic rods. Systemic ciprofloxacin appears to be capable of eradicating these potential pathogens from deep periodontal pockets.

Local ofloxacin delivery using a controlled-release insert (PT-01) in the human periodontal pocket

PT-01, a controlled-release insert, was developed for topical chemotherapy in periodontal disease. It is a soluble insert that consists of fast-release and sustained-release parts containing ofloxacin (OFLX) as an antibacterial agent. In this study, the release profile of OFLX from PT-01 was investigated in vitro. Twelve adult volunteers were administered OFLX as PT-01 or as an aqueous solution into their periodontal pockets, OFLX concentrations in gingival crevicular fluid (GCF) were evaluated from the viewpoint of pharmacokinetics. The in vitro release profile of OFLX from PT-01 showed a biphasic pattern. The release rate of OFLX was relatively rapid in the early phase and slow thereafter. When OFLX aqueous solution was administered into periodontal pockets, the OFLX level in GCF rapidly decreased to be about 1/100 after 30 minutes. When PT-01 was inserted into the pockets, the OFLX level in GCF immediately reached a peak (about 12 mg/ml), and gradually decreased until the 3rd day, and maintained a constant level above 2 micrograms/ml, the effective minimum antibacterial concentration for periodontopathic microorganisms, from the 3rd to 7th day after insertion. No side-effects were observed in the volunteers who received the PT-01 insert. The above results suggest that PT-01 is a suitable pharmaceutical preparation for periodontal chemotherapy.

The effect of ofloxacin on experimental periodontitis in hamsters infected with Actinomyces viscosus ATCC 15987

Syrian hamsters were infected with Actinomyces viscosus ATCC 15987 by inoculation into the oral cavity to induce experimental periodontitis. The effect of an antibiotic, ofloxacin (OFLX), on the experimental periodontitis was examined. In Group A, OFLX gel was applied daily to the gingival mucosa, 2 weeks after bacterial inoculation. Groups B and C were an infected control and a noninfected control, respectively. The hamsters in these three groups were fed a powdered high-sucrose diet. The hamsters in Group D, also a noninfected group, were fed an ordinary solid diet. Salivary occult blood test, evaluation of gingival and plaque index, measurement of alveolar bone loss, bacterial examination, and histological observation were performed 11 weeks after infection. Group B exhibited significantly higher levels of gingival index, plaque index, and alveolar bone loss than the noninfected controls. Severe inflammation of the gingivae, formation of gingival pockets, migration of many inflammatory cells, and obvious bone loss were also observed in Group B. However, these inflammatory changes were milder in Group A, which was treated with OFLX.