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Targeting antibiotic tolerance in anaerobic biofilms associated with oral diseases: Human antimicrobial peptides LL-37 and lactoferricin enhance the antibiotic efficacy of amoxicillin, clindamycin and metronidazole. Anaerobe 2021; 71:102439. [PMID: 34454095 DOI: 10.1016/j.anaerobe.2021.102439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/27/2021] [Accepted: 08/22/2021] [Indexed: 11/23/2022]
Abstract
Antimicrobial peptides are receiving increasing attention as potential therapeutic agents for treating biofilm-related infections of the oral cavity. Many bacteria residing in biofilms exhibit an enhanced antibiotic tolerance, which grants intrinsically susceptible microorganisms to survive lethal concentrations of antibiotics. In this study, we examined the effects of two endogenous human antimicrobial peptides, LL-37 and human Lactoferricin, on the antibiotic drug efficacy of amoxicillin, clindamycin and metronidazole in two types of polymicrobial biofilms, which aimed to represent frequent oral diseases: (1) facultative anaerobic (Streptococcus mutans, Streptococcus sanguinis, Actinomyces naeslundii) and (2) obligate anaerobic biofilms (Veillonella parvula, Parvimonas micra, Fusobacterium nucleatum). LL-37 and Lactoferricin enhanced the anti-biofilm effect of amoxicillin and clindamycin in facultative anaerobic biofilms. Metronidazole alone was ineffective against facultative anaerobic biofilms, but the presence of LL-37 and Lactoferricin led to a greater biofilm reduction. Obligate anaerobic biofilms showed an increased drug tolerance to amoxicillin and clindamycin, presumably due to metabolic downshifts of the bacteria residing within the biofilm. However, when combined with LL-37 or Lactoferricin, the reduction of obligate anaerobic biofilms was markedly enhanced for all antibiotics, even for amoxicillin and clindamycin. Furthermore, our results suggest that antimicrobial peptides enhance the dispersion of matured biofilms, which may be one of their mechanisms for targeting biofilms. In summary, our study proves that antimicrobial peptides can serve as an auxiliary treatment strategy for combatting enhanced antibiotic tolerance in bacterial biofilms.
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Guerrero A, Nibali L, Lambertenghi R, Ready D, Suvan J, Griffiths GS, Wilson M, Tonetti MS. Impact of baseline microbiological status on clinical outcomes in generalized aggressive periodontitis patients treated with or without adjunctive amoxicillin and metronidazole: an exploratory analysis from a randomized controlled clinical trial. J Clin Periodontol 2014; 41:1080-9. [DOI: 10.1111/jcpe.12299] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Adrián Guerrero
- Graduate Periodontology; University of Granada and Private Periodontal Practice; Málaga Spain
| | - Luigi Nibali
- University College London (UCL) Eastman Dental Institute; London UK
| | | | - Derren Ready
- PHL London; Public Health England; London UK
- Department of Microbial Diseases; Eastman Dental Institute and Hospital; University College London; London UK
| | - Jean Suvan
- University College London (UCL) Eastman Dental Institute; London UK
| | - Gareth S. Griffiths
- Academic Unit of Restorative Dentistry; University of Sheffield; Sheffield UK
| | - Michael Wilson
- Department of Microbial Diseases; Eastman Dental Institute and Hospital; University College London; London UK
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Sato S, Fonseca MJV, Ciampo JOD, Jabor JR, Pedrazzi V. Metronidazole-containing gel for the treatment of periodontitis: an in vivo evaluation. Braz Oral Res 2009; 22:145-50. [PMID: 18622484 DOI: 10.1590/s1806-83242008000200009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 06/12/2007] [Indexed: 11/22/2022] Open
Abstract
The aim of this investigation was to monitor metronidazole concentrations in the gingival crevicular fluid (GCF) collected from periodontal pockets of dogs after treatment with an experimental 15% metronidazole gel. Five dogs had periodontitis induced by cotton ligatures placed subgingivally and maintained for a 30-day period. After the induction period, only pockets with 4 mm or deeper received the gel. Each pocket was filled up to the gingival margin by means of a syringe with a blunt-end needle. GCF was collected in paper strips and quantified in an electronic device before and after 15 minutes, 1 h, 6 h, 24 h and 48 h of gel administration. The GCF samples were assayed for metronidazole content by means of a high performance liquid chromatography method. Concentrations of metronidazole in the GCF of the 5 dogs (mean +/- SD, in microg/mL) were 0 +/- 0 before gel application and 47,185.75 +/- 24,874.35 after 15 minutes, 26,457.34 +/- 25,516.91 after 1 h, 24.18 +/- 23.11 after 6 h, 3.78 +/- 3.45 after 24 h and 3.34 +/- 5.54 after 48 h. A single administration of the 15% metronidazole gel released the drug in the GCF of dogs in levels several-fold higher than the minimum inhibitory concentration for some periodontopathogens grown in subgingival biofilms for up to one hour, but metronidazole could be detected in the GCF at least 48 hours after the gel application.
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Affiliation(s)
- Sandra Sato
- Department of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
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Yu L, Liu H, E L, Wu X, Wang D. Uptake of Metronidazole by Human Gingival Fibroblasts. J Periodontol 2009; 80:993-8. [DOI: 10.1902/jop.2009.080617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Isla A, Canut A, Rodríguez-Gascón A, Planells P, Beltrí-Orta P, Salmerón-Escobar JI, Labora A, Pedraz JL. [Antibiotic therapy in odontogenic infections in children and adolescents: pharmacokinetic/pharmacodynamic analysis]. Enferm Infecc Microbiol Clin 2008; 26:621-8. [PMID: 19100192 DOI: 10.1016/s0213-005x(08)75278-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The objective of this study was to evaluate the efficacy of the most commonly used antimicrobial treatments in odontogenic infections in children and adolescents on the basis of pharmacokinetic/ pharmacodynamic (PK/PD) criteria. METHODS Unbound drug plasma concentration-time curves were simulated with mean population pharmacokinetic parameters of amoxicillin, co-amoxiclav, cefuroxime axetil, spiramycin, clindamycin, azithromycin, and metronidazole. For drugs showing time-dependent antibacterial killing, the time above MIC90 of the pathogens studied was calculated (T>MIC). For drugs with concentration-dependent bactericidal activity, the area under the concentration-time curve (AUC)/MIC90 ratio was calculated. RESULTS Adequate efficacy indexes (T>MIC>40%) against all the microorganisms examined with the exception of Veillonella spp. were obtained with co-amoxiclav (80 mg/kg/day). Clindamycin (40 mg/kg/day) obtained adequate PK/PD indexes except for Lactobacillus, Actinobacillus actinomycetemcomitans, penicillin-resistant Peptostreptococcus, and Eikenella corrodens. High-dose amoxicillin yielded unsatisfactory results against many bacterial species. Azithromycin and metronidazole showed inadequate efficacy indexes against the majority of pathogens studied (AUC/MIC90<25). CONCLUSION When antibiotic therapy is needed for odontogenic infections in children and adolescents, the most active empirical therapeutic choice is co-amoxiclav with high doses of amoxicillin. Clindamycin can be used as an alternative option. These results should be confirmed in clinical trials, in which the PK/PD approach could be useful for the design and assessment of results.
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Affiliation(s)
- Arantxazu Isla
- Laboratorio de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Universidad del País Vasco, Spain
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Kaner D, Christan C, Dietrich T, Bernimoulin JP, Kleber BM, Friedmann A. Timing Affects the Clinical Outcome of Adjunctive Systemic Antibiotic Therapy for Generalized Aggressive Periodontitis. J Periodontol 2007; 78:1201-8. [PMID: 17608574 DOI: 10.1902/jop.2007.060437] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Systemic antibiotics improve the outcome of scaling and root planing (SRP) in patients exhibiting severe periodontitis. This study evaluated the influence of timing of adjunctive systemic antibiotics in the sequence of periodontal therapy. METHODS Two cohorts of patients with generalized aggressive periodontitis and treated by SRP, adjunctive antibiotics, and supportive periodontal therapy (SPT) were analyzed retrospectively. Cohort A (17 patients; 36 +/- 5 years of age) received systemic amoxicillin/metronidazole immediately after SRP ("immediate"); cohort B (17 patients; 36 +/- 4 years of age) received the same regimen 3 months after SRP, following SPT, including subgingival reinstrumentation ("late"). Clinical parameters, including probing depth (PD), relative attachment level (RAL), bleeding on probing (BOP), and suppuration, were recorded with a pressure-sensitive electronic probe at baseline and 3 and 6 months after SRP. RESULTS Significant time*group interactions were found for all clinical parameters except BOP, i.e., timing of antibiotic therapy affected the course of clinical changes over time. Immediate antibiotic therapy produced significantly higher initial changes (0 to 3 months) in PD and RAL. Late antibiotic therapy at 3 months resulted in additional significant improvements in all clinical parameters between 3 and 6 months. In initially deep sites (baseline PD >6 mm), improvements in PD and RAL over 6 months were significantly higher with immediate antibiotic therapy compared to late antibiotic therapy. CONCLUSION Within the limits of a retrospective analysis, these findings indicate that administration of amoxicillin/metronidazole immediately after initial SRP provides more PD reduction and RAL "gain" in initially deep sites than late administration at SPT with reinstrumentation after 3 months.
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Affiliation(s)
- Doğan Kaner
- Institute for Periodontology and Synoptic Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Barat R, Srinatha A, Pandit JK, Ridhurkar D, Balasubramaniam J, Mittal N, Mishra DN. Niridazole biodegradable inserts for local long-term treatment of periodontitis: possible new life for an orphan drug. Drug Deliv 2006; 13:365-73. [PMID: 16877312 DOI: 10.1080/10717540500398126] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Periodontal pocket inserts of niridazole (NZ) made with Resomer(R) (grades RG 503H and RG858, designated as RH and RG, respectively) were studied. Various formulation variables were evaluated to obtain a biodegradable delivery systems showing device degradation and drug depletion parallel to each other in vitro. Drug release from the prepared inserts was evaluated using a static dissolution setup (for 1 month). Incorporation of 3 parts of RG in 1 part of RH inserts caused a 50% decrease in the initial release rate. The RH-NZ inserts showed a spurt in release around the 10th day of the study, which coincided with the decrease in device weight, suggesting onset of device degradation. Pilot-scale clinical trials in 12 patients indicated improvements in clinical indices from the baseline values. The average pocket depth was reduced significantly (alpha = 0.05) from 6.34 +/- 1.86 mm at baseline to 5.94 +/- 0.28 mm after 28 days of treatment.
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Affiliation(s)
- Romi Barat
- Ranbaxy Research Laboratories, Gurgaon, India
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Sagan C, Salvador A, Dubreuil D, Poulet PP, Duffaut D, Brumpt I. Simultaneous determination of metronidazole and spiramycin I in human plasma, saliva and gingival crevicular fluid by LC–MS/MS. J Pharm Biomed Anal 2005; 38:298-306. [PMID: 15925222 DOI: 10.1016/j.jpba.2004.12.033] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2004] [Revised: 12/21/2004] [Accepted: 12/24/2004] [Indexed: 10/25/2022]
Abstract
An analytical validation of a new liquid chromatographic-mass spectrometric (LC-MS/MS) method for simultaneous determination of metronidazole and spiramycin I concentrations in human plasma, saliva and gingival crevicular fluid (GCF) is presented. Ornidazole was used as an internal standard, and sample pre-treatment consisted of a liquid-liquid extraction. Chromatographic separation was achieved on a 5 microm Kromasil C18 column (150 mm x 4.6 mm i.d., particle size 5 microm), with a gradient using acetonitrile, water and formic acid at a flow rate of 0.9 ml/min. The methods were validated in terms of intra- and inter-batch precision (<7.1% in plasma, 12% in saliva and 9.2% in GCF, respectively) and accuracy (within +/-8.7% in plasma, within +/-8.7%, except LDQ level within +/-15.4% in saliva and within +/-10.7% in GCF), linearity, specificity, recovery (extraction efficiency), matrix effect, dilution process, stability in human plasma and saliva after three freeze-thaw cycles, stability in human plasma and saliva at ambient temperature and stability of the extracts in the automatic injector of the HPLC system. The methods are applicable for accurate and simultaneous monitoring of the plasma, saliva and gingival crevicular fluid levels of metronidazole and spiramycin I from pharmacokinetic studies.
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Affiliation(s)
- Cyriaque Sagan
- CEPHAC Europe, 90 Avenue des Hauts de la Chaume, B.P. 28, 86281 Saint Benoît, France.
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Abstract
This position paper addresses the role of systemic antibiotics in the treatment of periodontal disease. Topical antibiotic therapy is not discussed here. The paper was prepared by the Research, Science and Therapy Committee of the American Academy of Periodontology. The document consists of three sections: 1) concept of antibiotic periodontal therapy; 2) efficacy of antibiotic periodontal therapy; and 3) practical aspects of antibiotic periodontal therapy. The conclusions drawn in this paper represent the position of the American Academy of Periodontology and are intended for the information of the dental profession.
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Pähkla ER, Koppel T, Saag M, Pähkla R. Metronidazole concentrations in plasma, saliva and periodontal pockets in patients with periodontitis. J Clin Periodontol 2005; 32:163-6. [PMID: 15691346 DOI: 10.1111/j.1600-051x.2005.00653.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Metronidazole is widely used antibacterial compound in the treatment of some types of periodontal disease. Pharmacokinetics of metronidazole in plasma has been well-described but few data exist about penetration of the drug to the gingival crevice fluid. The aim of the present study was to compare the concentrations of metronidazole in plasma, saliva and gingival crevice fluid in patients with periodontitis after multiple administration. MATERIALS AND METHODS Eleven patients with severe generalised adult periodontitis participated in the study. Metronidazole, 500 mg, was administered orally two or three times per day for at least 2 days before sample collection. Samples were collected 2 h after last dose. Metronidazole concentrations in all fluids were measured with high-performance liquid chromatography. RESULTS Mean drug concentrations in plasma, saliva and crevice fluid were 14.33, 15.15 and 12.86 microg/ml, respectively. Difference between plasma and crevice fluid or between plasma and saliva did not reach statistical significance. CONCLUSION Present study revealed that metronidazole penetrates well into gingival crevice fluid and saliva. Metronidazole concentrations in crevice fluid are about equal to the protein unbound drug concentrations in plasma. Therefore, general pharmacokinetic data of metronidazole can be also applied in the treatment of periodontal disease and in the design of respective treatment regimens.
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Affiliation(s)
- Ene-Renate Pähkla
- Department of Stomatology, University of Tartu, Ravila Str. 19, 51014 Tartu, Estonia
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Isla A, Canut A, Gascón AR, Labora A, Ardanza-Trevijano B, Solinís MA, Pedraz JL. Pharmacokinetic/Pharmacodynamic Evaluation of Antimicrobial Treatments of Orofacial Odontogenic Infections. Clin Pharmacokinet 2005; 44:305-16. [PMID: 15762771 DOI: 10.2165/00003088-200544030-00006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To evaluate the efficacy of antimicrobial therapy in oral odontogenic infections using estimated pharmacokinetic/pharmacodynamic parameters or efficacy indices, and to compare pharmacokinetic/pharmacodynamic breakpoints with National Committee for Clinical Laboratory Standards' (NCCLS) breakpoints. STUDY DESIGN Retrospective literature search to obtain minimum inhibitory concentration (MIC) values, pharmacokinetic parameters of antimicrobials and NCCLS breakpoints. Pharmacokinetic simulations were carried out using WinNonlin software (Pharsight Corporation, Mountain View, CA, USA). METHODS For antimicrobials with time-dependent activity, the time that the plasma drug concentration exceeds the MIC as the percentage of dose interval at steady state was calculated. For antimicrobials with concentration-dependent activity, the total area under the plasma concentration-time curve over 24 hours at steady state divided by the MIC was calculated. Pharmacokinetic/pharmacodynamic breakpoints were calculated according to these parameters. RESULTS Only amoxicillin/clavulanic acid and clindamycin showed adequate efficacy indices against the most commonly isolated bacteria in odontogenic infections. Metronidazole reached good indices against anaerobes only. Pharmacokinetic/pharmacodynamic susceptibility breakpoints do not coincide exactly with NCCLS breakpoints. CONCLUSION Owing to the scarcity of double-blind, clinical trials on the use of antimicrobials in endodontics, this study may be useful in determining the best antimicrobial treatment in these infections. However, as we have not used concentration data in infected tissue to determine pharmacokinetic/pharmacodynamic indices, it would be necessary to design clinical trials in order to confirm these results.
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Affiliation(s)
- Arantxa Isla
- Laboratory of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of the Basque Country, Vitoria-Gasteiz, Spain
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Tözüm TF, Yildirim A, Cağlayan F, Dinçel A, Bozkurt A. Serum and gingival crevicular fluid levels of ciprofloxacin in patients with periodontitis. J Am Dent Assoc 2004; 135:1728-32. [PMID: 15646608 DOI: 10.14219/jada.archive.2004.0127] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of antibiotics as an adjunctive therapy in the treatment of periodontal diseases is of special interest to dental practitioners. In addition to using an appropriate antibacterial agent, clinicians may find it useful to determine the local and systemic concentrations of antibiotics in infected periodontal sites to reduce the levels of bacteria. The purpose of this study was to determine the serum and gingival crevicular fluid, or GCF, concentrations of systemic ciprofloxacin in patients with periodontitis. METHODS Ten subjects with chronic periodontitis received ciprofloxacin (500 milligrams) twice daily for five days. The authors collected GCF and serum samples immediately after administering the first dose (baseline = 0 hours) and at consecutive time points. The orifice method was used for GCF sampling, and 5 milliliters of venous blood was drawn for serum analysis. The authors used high-performance liquid chromatography to determine ciprofloxacin concentrations in GCF and serum. RESULTS The authors found that ciprofloxacin concentrations in GCF were significantly higher than concentrations in serum at two, four, seven, 24 and 120 hours. Ciprofloxacin reached the maximum concentration, or Cmax (3.72 micrograms/ mL), in GCF two hours after the initial dose was administered. The concentration decreased to 2.06 microg/mL 24 hours after the initial administration of the drug. Serum Cmax was 2.58 microg/mL at 1.5 hours, and the concentration decreased to 0.26 microg/mL at 24 hours. CONCLUSION The results of this clinical study show that ciprofloxacin is found in GCF and its concentration in GCF is significantly higher than that in serum. CLINICAL IMPLICATIONS Ciprofloxacin may be useful in treating patients with periodontitis because it reaches higher concentrations in GCF than in serum.
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Affiliation(s)
- Tolga F Tözüm
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Sihhiye, Ankara, Turkey.
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Affiliation(s)
- Clay B Walker
- Periodontal Disease Researach Clinics, University of Florida, Gainesville, U.S.A
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Affiliation(s)
- Jørgen Slots
- Department of Periodontology, School of Dentistry, University of Southern California, Los Angeles, USA
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Kurtiş B, Unsal B, Cetiner D, Gültekin E, Ozcan G, Celebi N, Ocak O. Effect of polylactide/glycolide (PLGA) membranes loaded with metronidazole on periodontal regeneration following guided tissue regeneration in dogs. J Periodontol 2002; 73:694-700. [PMID: 12146527 DOI: 10.1902/jop.2002.73.7.694] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Bioabsorbable membranes have been successfully used for guided tissue regeneration (GTR) and local delivery systems because they are biocompatible and do not require second surgery for removal. Several studies have demonstrated that metronidazole, when applied topically, produced immediate effects on microbiological and clinical parameters, most notably a reduction in probing depth and loss of attachment. The purpose of this study was to evaluate the regenerative potential of a metronidazole-loaded biodegradable (polylactide/glycolide) (PLGA) GTR membrane in dogs. METHODS Six male adult dogs with 36 created osseous defects were enrolled. Bilateral dehiscence type defects in 5 mm diameter were created at buccal aspect of the alveolar bone in maxillary premolar teeth. After full thickness flap elevation, exposed root surfaces were thoroughly planed. In the experimental sites, PLGA membranes with or without metronidazole were fitted and placed over the defects. On the control defects only root planing was performed. Gingival flaps were replaced slightly coronal to the cemento-enamel junction. Animals were sacrificed at 60 days. The histometric analysis was evaluated with the following parameters: defect height (DH), apical extension of junctional epithelium (AEJE), new cementum height (NCH), new bone height (NBH), and new gingival connective tissue height (NCTH). RESULTS Postoperative clinical healing was similar in the 3 groups. There were no statistically significant differences between the 2 experimental groups in any parameters. Statistically significant differences were observed for AEJE, NCH, NBH, and NCTH in experimental groups when compared with the controls. Statistically significantly greater NCH, NBH, and NCTH were seen in the experimental groups than the controls and control defects showed longer AEJE than the experimental defects. CONCLUSIONS These results suggest that PLGA membranes with and without metronidazole may have a beneficial effect on periodontal regeneration.
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Affiliation(s)
- Bülent Kurtiş
- Gazi University, Faculty of Dentistry, Department of Periodontology, Ankara, Turkey.
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Loesche WJ. The antimicrobial treatment of periodontal disease: changing the treatment paradigm. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 2000; 10:245-75. [PMID: 10759408 DOI: 10.1177/10454411990100030101] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the last 100 years, methods of surgical periodontal treatment have enjoyed a history of success in improving oral health. The paradigm of care is based on the "non-specific plaque hypothesis"--that is, the overgrowth of bacterial plaques cause periodontal disease, and the suppression of this overgrowth reduces disease risk. The central feature of this approach to care is the removal of inflamed gingival tissue around the teeth to reduce periodontal pocket depth, thereby facilitating plaque removal by the dentist and by the patient at home. Over the last 30 years, with the recognition that periodontal disease(s) is caused by specific bacteria and that specific antimicrobial agents can reduce or eliminate the infection, a second paradigm has developed. This new paradigm, the "specific plaque hypothesis", focuses on reducing the specific bacteria that cause periodontal attachment loss. The contrast between the two paradigms can be succinctly stated as follows: The antimicrobial therapy reduces the cause, while the surgical therapy reduces the result of the periodontal infection. The specific plaque hypothesis has two important implications. First, with the increasing attention to evidence-based models for prevention, treatment, outcome assessment, and reimbursement of care, increasing attention and financial effort will be channeled into effective preventive and treatment methods. Second, the recent observations that periodontal infections increase the risk of specific systemic health problems, such as cardiovascular disease, argue for the prevention and elimination of these periodontal infections. This review highlights some of the evidence for the specific plaque hypothesis, and the questions that should be addressed if antimicrobial agents are to be used responsively and effectively.
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Affiliation(s)
- W J Loesche
- University of Michigan School of Dentistry, Ann Arbor 48109, USA
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Söder B, Nedlich U, Jin LJ. Longitudinal effect of non-surgical treatment and systemic metronidazole for 1 week in smokers and non-smokers with refractory periodontitis: a 5-year study. J Periodontol 1999; 70:761-71. [PMID: 10440638 DOI: 10.1902/jop.1999.70.7.761] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Periodontitis consists of a mixture of diseases, most of which respond favorably to traditional mechanical therapy. It is now recognized that advanced periodontitis does not always respond to conventional management with scaling, periodontal surgery, and oral hygiene measures. However, various types of antibiotics given systemically or locally improve the success rate of periodontal therapy. In short-term studies, it has been shown that metronidazole, when systemically administered after debridement, resulted in treatment benefits including less need for surgical intervention. METHODS In this double-blind study, we evaluated periodontal treatment involving initial non-surgical treatment, systemic administration of metronidazole for 1 week, and then follow-ups for scaling and root planing every 6 months, for 5 years. The study population consisted of 64 subjects (37 smokers and 27 non-smokers), mean age 36.3 (+/-3.0 SD) years, with severe periodontal disease. After initial scaling and root planing, patients were randomly assigned to the intervention or placebo groups: 400 mg metronidazole or a placebo administered at 8-hour intervals for 1 week. The participants underwent an extensive clinical periodontal examination. Gingival crevicular fluid (GCF) was analyzed for spirochetes and granulocytes. Samples were cultured for Actinobacillus actinomycetemcomitans (A.a.), Porphyromonas gingivalis (Pg.), and Prevotella intermedia (Pi.). RESULTS The number of patients infected with A.a., Pg., Pi., and spirochetes decreased during the study. Most patients who harbored spirochetes at the end of the study had these microorganisms at the beginning. Smokers responded less favorably to periodontal therapy than non-smokers. Non-smoking patients who required only non-surgical therapy in the intervention group showed statistically significant improvement in the clinical parameters after 5 years. Patients with complete healing, defined as the absence of inflamed sites > or =5 mm, after 5 years were found only in the intervention group. The patients considered healthy after 5 years were the same patients found to be healthy after 6 months. CONCLUSIONS Decisive factors in the sustained long-term improvement of patients who respond satisfactorily to treatment are probably initial scaling and root planing; a brief course of metronidazole; and regular follow-up examinations at 6-month intervals for oral hygiene and scaling and root planing.
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Affiliation(s)
- B Söder
- Department of Clinical Research, Faculty of Odontology, Karolinska Institutet, Stockholm, Sweden.
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Zucchelli G, Sforza NM, Clauser C, Cesari C, De Sanctis M. Topical and systemic antimicrobial therapy in guided tissue regeneration. J Periodontol 1999; 70:239-47. [PMID: 10225539 DOI: 10.1902/jop.1999.70.3.239] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Bacterial contamination of membrane material negatively affects healing after guided tissue regeneration (GTR) procedures; conversely, flap connective tissue integration on barrier material improves the clinical outcomes. The objective of this study was to evaluate the effect of topical application of antibiotics on: 1) clinical outcomes of GTR surgical procedures using titanium reinforced expanded polytetrafluoroethylene (ePTFE) periodontal membrane; 2) bacterial colonization of membrane material; and 3) flap connective tissue-membrane integration. METHODS Fifty-six deep interproximal bony defects were treated with GTR surgical procedures using titanium reinforced ePTFE periodontal membranes. Patients were randomly assigned to 1 of the 2 antimicrobial treatment groups: the test group received weekly topical application of 25% metronidazole gel and the control group received systemic antibiotics (amoxicillin plus clavulanic acid 1 g/day for 14 days). Clinical outcomes were assessed at 1 year; the amount of bacterial contamination and connective tissue integration on membrane material was evaluated at time of membrane removal by means of a morphological (SEM) method. RESULTS No statistically significant difference was found between test and control groups in terms of clinical attachment (CAL) gain (baseline CAL - 12 months CAL; P = 0.2) and probing depth (PD) reduction (baseline PD - 12 months PD; P = 0.6). A greater increase in gingival recession (REC) (12 months REC - baseline REC) was found in the test group compared to the control group (P = 0.003). The SEM analysis revealed no statistically significant (t test) difference between test and control groups in the number of fields positive to integrated connective tissue (P = 0.82), while the number of fields positive to bacteria was statistically higher (P < 0.001) in the control group. CONCLUSIONS Local antibiotic administration is more effective than systemic use in preventing membrane contamination, but it does not improve clinical outcomes due to an interference of the vehicle (gel) with gingival tissues which may reduce the potential benefits derived from better control of the bacterial load.
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Affiliation(s)
- G Zucchelli
- Department of Periodontology, Faculty of Odontology, Bologna University, Italy.
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19
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Tenenbaum H, Jehl F, Gallion C, Dahan M. Amoxicillin and clavulanic acid concentrations in gingival crevicular fluid. J Clin Periodontol 1997; 24:804-7. [PMID: 9402501 DOI: 10.1111/j.1600-051x.1997.tb01193.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The beta-lactams are bactericidal antibiotics, but some of them may be inactivated by bacterial beta-lactamases which destroy the beta-lactam ring. The inactivation of amoxicillin by beta-lactamases of gram negative anaerobic bacteria can be circumvented by the addition of clavulanic acid, a beta-lactamases inhibitor. Thus, most of these bacteria are susceptible to this combination. The aim of this study was to investigate the concentrations of amoxicillin and clavulanic acid in gingival crevicular fluid (GCF). These concentrations were measured in 20 patients with rapidly progressive periodontitis 1 h after a dose of 500 mg (1 tablet Augmentin) on day 0 and 1 h after the 10th intake on day 3. For the sampling of GCF, Periopapers were introduced in 16 gingival sites per subject and time. The GCF volumes collected were estimated using the Periotron 6000. A high performance liquid chromatography method has been developed for the determination of amoxicillin and clavulanic acid in microsamples (1 to 10 microliters) of GCF. The concentrations of amoxicillin and clavulanic acid were respectively, 14.05 micrograms ml-1 and 0.40 microgram ml-1 at day 0, 13.93 micrograms ml-1 and 0.37 microgram ml-1 at day 3. Effective levels of amoxicillin and clavulanic acid, well above the minimal inhibitory concentrations of some susceptible periodontal anaerobes (P. intermedia) involved in destructive periodontal diseases, are achieved following the multiple administration of amoxicillin combined with clavulanic acid.
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Affiliation(s)
- H Tenenbaum
- Department of Periodontology, Dental Faculty, University Louis Pasteur, Strasbourg, France
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20
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Affiliation(s)
- C H Drisko
- Department of Periodontics, Endodontics, and Dental Hygiene, University of Louisville, Kentucky, USA
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21
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Sarkiala-Kessel EM, Järvinen A, Nokelainen M, Asikainen S. Concentrations of tinidazole in gingival crevicular fluid and plasma in dogs after multiple dose administration. J Vet Pharmacol Ther 1996; 19:171-5. [PMID: 8803874 DOI: 10.1111/j.1365-2885.1996.tb00035.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Tinidazole 15 mg/kg was administered to eight Beagle dogs with gingivitis or periodontitis twice daily for 3 days. Tinidazole concentrations in blood and gingival crevicular fluid (GCF) were measured 1, 3, 6 and 9 h after the morning dose each day. The concentration of tinidazole was determined by high performance liquid chromatography (HPLC). The mean concentration of tinidazole in GCF for each dog ranged from 6.05 to 9.32 micrograms/mL at different time points after the first dose, and on the first day the highest concentration was observed 6 h after the drug administration. Tinidazole concentrations were 34 +/- 4%-72 +/- 9% (mean +/- SEM) of simultaneous plasma concentration. At steady-state, on the third treatment day, the mean tinidazole concentrations in GCF ranged from 6.68 to 13.1 micrograms/mL, i.e. 44 +/- 6%-75 +/- 25% of the corresponding concentrations in plasma. Tinidazole concentration in GCF exceeded the MIC values for putative path-ogenic periodontal bacteria and it is concluded that, when indicated, tinidazole could be used for chemotherapy of periodontitis in dogs.
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Affiliation(s)
- E M Sarkiala-Kessel
- Department of Clinical Sciences, College of Veterinary Medicine, Helsinki, Finland
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22
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Abstract
Antimicrobial agents are of value in the management of certain types of periodontal disease, notably early onset, juvenile and refractory periodontitis. The diagnosis of these conditions is often made on clinical grounds but microbial sampling of the pocket flora is of value in determining the type of antimicrobial therapy. Routine systemic use of these drugs in the management of chronic adult periodontitis is contraindicated, and is no substitute for root surface debridement and thorough supragingival plaque control. Tetracyclines and metronidazole are the agents most frequently used in the management of periodontal disease. Both drugs can be given systemically or applied topically into the periodontal pocket. The latter route is preferred since the dose is reduced considerably, but the local tissue concentration is increased. The efficacy of local drug delivery is dependent upon the release kinetics of the drug from the delivery vehicle. Although local application can be time consuming, it reduces the risk of adverse reactions and drug interactions. The tetracyclines have the additional advantage of inhibiting collagenases. This property may facilitate repair and new attachment formation. Systemic metronidazole appears to be useful as an adjunct to conventional periodontal therapy. The combination of metronidazole 250 mg and amoxycillin 375 mg has been shown to be effective in the treatment of refractory periodontitis, including cases which are resistant to tetracycline. Clindamycin has also been used in the management of refractory periodontitis, but the unwanted effects of this drug must limit its systemic use for this purpose.
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Affiliation(s)
- R A Seymour
- Department of Restorative Dentistry, Dental School, University of Newcastle upon Tyne, UK
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23
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Sander L, Frandsen EV, Arnbjerg D, Warrer K, Karring T. Effect of local metronidazole application on periodontal healing following guided tissue regeneration. Clinical findings. J Periodontol 1994; 65:914-20. [PMID: 7823272 DOI: 10.1902/jop.1994.65.10.914] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The effect of periodontal healing after guided tissue regeneration (GTR) in association with local application of metronidazole gel was evaluated in this study. Twelve patients with one pair of vertical periodontal bone defects of comparable size and configuration participated in the study. In a matched paired design, the test defects were treated by GTR using expanded polytetrafluoroethylene (ePTFE) membranes in combination with local application of metronidazole gel. The controls were treated in the same way except for application of metronidazole. During the first month of membrane implantation, no statistically significant differences between test and control surfaces were noted with respect to inflammation of the marginal gingiva. Six weeks following insertion, the membranes were removed. Six months after removal of the membrane, the median gain in probing attachment level as a percentage of the initial defect depth was 92% for test defects and 50% for control defects (P = .001). No statistically significant differences were found between test and control sites regarding plaque, bleeding on probing, reduction in pocket depth, gain in bone height, or recession of the gingival margin. In conclusion, the results of the present study indicate that local application of metronidazole gel has a beneficial effect on healing of periodontal vertical defects treated by guided tissue regeneration.
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Affiliation(s)
- L Sander
- Department of Periodontology, Royal Dental College, Faculty of Health Sciences, University of Aarhus, Denmark
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24
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Frandsen EV, Sander L, Arnbjerg D, Theilade E. Effect of local metronidazole application on periodontal healing following guided tissue regeneration. Microbiological findings. J Periodontol 1994; 65:921-8. [PMID: 7823273 DOI: 10.1902/jop.1994.65.10.921] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The bacteriological colonization of healing periodontal defects was investigated after treatment with guided tissue regeneration using expanded polytetrafluoroethylene membranes together with local metronidazole gel (25%, 250 mg/g). Twelve patients, each with one pair of comparable defects, had the test defect treated with the membrane plus metronidazole gel and the control defect treated with the membrane alone. Thirty weeks after removal of the membrane, the median gain in probing attachment level as a percentage of the initial defect depth was 92% for the test defects and 50% for the control defects (P = 0.001). The median number of cultivable bacteria decreased from 1.2 x 10(6) at the presurgical examination to 3.0 x 10(5) at the one week examination in the test group (P = 0.02), whereas an increase was observed in the control group. Similarly, a lower median proportion of black-pigmented Gram-negative anaerobic rods was observed one week postsurgically in the test group (0.004%) compared to the control group (3.5%) (P = 0.02). Two weeks after membrane insertion, and at all following examinations, no microbiological differences between test and control group were observed. Consequently, the influence of the metronidazole gel on the treatment result appears to have been confined to the initial regeneration phase. Despite the good clinical results in the test group, all membranes from both test and control pockets were heavily colonized with bacteria at the time of removal. To ensure maximal periodontal regeneration with formation of bone, future research in this area should concentrate on reducing the microbial colonization of the wound area.
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Affiliation(s)
- E V Frandsen
- Department of Oral Biology, Royal Dental College, Faculty of Health Sciences, University of Aarhus, Denmark
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25
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Rotzetter PA, Le Liboux A, Pichard E, Cimasoni G. Kinetics of spiramycin/metronidazole (Rodogyl) in human gingival crevicular fluid, saliva and blood. J Clin Periodontol 1994; 21:595-600. [PMID: 7806675 DOI: 10.1111/j.1600-051x.1994.tb00749.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The peripheral distribution of spiramycin and metronidazole, which are combined in the proprietary drug "Rodogyl", has been studied in gingival fluid, saliva and blood after a single administration to 12 healthy volunteers and after repeated administration to 4 patients with recurring severe periodontitis. Analysis of the 2 antibiotics have been performed at regular intervals during the 24-h period immediately following the administration to the volunteers and after the 1st and the 15th days of repeated administration to the patients. The results show that gingival fluid contains concentrations of spiramycin and metronidazole higher than those needed to inhibit the growth of periodontopathic bacteria. Spiramycin was found at higher concentrations in GCF than in blood, although this feature was not found for metronidazole, which was administered simultaneously and showed similar concentrations in both fluid and serum. Such high concentrations persist for a long time, and suggest the potential of this compound in the treatment of severe cases of periodontitis.
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Affiliation(s)
- P A Rotzetter
- Division of Oral Physiopathology and Periodontology, School of Dental Medicine, Medical Faculty, University of Geneva, Switzerland
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26
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Medlicott NJ, Ferry DG, Tucker IG, Rathbone MJ, Holborow DW, Jones DS. High Performance Liquid Chromatographic (HPLC) Assay for the Determination of Chlorhexidine in Saliva Film. ACTA ACUST UNITED AC 1994. [DOI: 10.1080/10826079408013183] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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27
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Medlicott NJ, Rathbone MJ, Tucker IG, Holborow DW. Delivery systems for the administration of drugs to the periodontal pocket. Adv Drug Deliv Rev 1994. [DOI: 10.1016/0169-409x(94)90033-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Tenenbaum H, Cuisinier FJ, Le Liboux A, Pichard E, Montay G, Frydman A. Secnidazole concentrations in plasma and crevicular fluid after a single oral dose. J Clin Periodontol 1993; 20:505-8. [PMID: 8354725 DOI: 10.1111/j.1600-051x.1993.tb00398.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Metronidazole and related nitroimidazole derivatives, including ornidazole and tinidazole, have been used successfully in the treatment of periodontal diseases. The purpose of this study was to measure secnidazole (another nitroimidazole derivative) concentrations in plasma and gingival crevicular fluid (GCF) after intake of a single oral dose. Secnidazole concentrations were estimated in 11 human healthy volunteers after a single dose of 2 g taken orally. Samples of blood and GCF were collected before intake and during the following 72 h. A high-performance liquid chromatography (HPLC) method has been developed for the determination of secnidazole in microsamples (1 to 3 microliters) of GCF. The mean peak blood and GCF levels were equal to 40.5 +/- 9.4 micrograms ml-1 at 2 h in blood and 26.4 +/- 7.0 micrograms ml-1 at 1 h in GCF, respectively. Apparent elimination half-life was 28.8 h (blood) and 30.4 h (GCF), respectively. These results show that the rate and extent-absorption of secnidazole are slightly higher in blood than in GCF, but the elimination of the drug is similar in the two body fluids.
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Affiliation(s)
- H Tenenbaum
- Department of Periodontology, University Louis Pasteur, Strasbourg, France
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29
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Walker CB, Gordon JM, Magnusson I, Clark WB. A role for antibiotics in the treatment of refractory periodontitis. J Periodontol 1993; 64:772-81. [PMID: 8410617 DOI: 10.1902/jop.1993.64.8s.772] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Refractory periodontitis is considered by many investigators to be a separate disease entity that is descriptive of a particular patient who has multiple sites, rather than a few individual sites, that do not respond to conventional periodontal treatment modalities. Such patients continue to demonstrate loss of attachment and alveolar bone despite frequent periodontal treatment which includes surgical intervention, scaling and root planing, and often systemically-administered tetracycline. Controlled clinical studies have demonstrated that both clindamycin-hydrochloride and amoxicillin/clavulanate potassium (Au) are beneficial when used in conjunction with periodontal scaling. Gordon et al. found improvements in attachment levels, inflammation, suppuration, and a decrease in pocket depths for up to 2 years following a 7-day course of clindamycin given in conjunction with a full-mouth scaling. The incidence of disease activity decreased from an annual rate of 8% of all sites prior to antibiotic treatment to 0.5% after treatment. Magnusson, reporting on a similar group treated with a 14-day course of Au, found an average loss of attachment of 2.2 mm and an increase in pocket depth of 1.5 mm in sites demonstrating disease progression prior to antibiotic treatment. At 3 months post-antibiotic therapy, these sites had regained an average of 2 mm of attachment and pocket depths had decreased an equivalent amount. Both attachment levels and pocket depths remained relatively stable for up to 12 months post-therapy. In an ongoing study, 30 subjects with refractory periodontitis were treated with either clindamycin or Au in conjunction with scaling or scaling plus a placebo. Prior to antibiotic treatment, but while being scaled at 3-month intervals, sites with disease activity lost an average 2.4 mm of attachment. At 3 months post-treatment, the clindamycin-treated group showed an average gain of 2.1 mm, the Au-treated group gained 1.9 mm, and the scaling group gained 1.4 mm in attachment. The clindamycin group remained relatively stable for up to 21 months and the Au group remained stable for about 15 months without additional treatment. Five of the 6 subjects treated with scaling alone required additional treatment within 9 months. Preliminary analyses have indicated that at least two patterns or rates of attachment loss may be associated with refractory periodontitis and that each pattern may be indicative of a different microflora. The pattern associated with a relatively rapid loss of attachment was characterized by a Gram-negative flora which contained spirochetes, P. intermedia, and Fusobacterium species.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- C B Walker
- Periodontal Disease Research Center, University of Florida, Gainesville
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30
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Loesche WJ, Grossman N, Giordano J. Metronidazole in periodontitis (IV). The effect of patient compliance on treatment parameters. J Clin Periodontol 1993; 20:96-104. [PMID: 8436638 DOI: 10.1111/j.1600-051x.1993.tb00336.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Patient compliance with the unsupervised usage of prescription medication can be poor. In the treatment of periodontal infections with systemic antimicrobial agents, in situations where the efficacy of the antimicrobial agent is being evaluated, non-compliance could underestimate the true efficacy of the agent. Metronidazole is an agent with reported success in the treatment of anaerobic periodontal infections. Metronidazole is particularly effective in vitro against spirochetes, and this efficacy was investigated as a means of measuring patient compliance with metronidazole usage. Patients who had high proportions of spirochetes, i.e., > 20%, in plaques removed from diseased periodontal sites, were given metronidazole (500 mg bid) under supervision. In all individuals who received the metronidazole, there was a significant and rapid decline and/or disappearance of spirochetes from the plaque during the time interval that metronidazole was detectable in the saliva. This observed decline in spirochetes was then used to determine which patients had been compliant in a double-blind clinical trial involving the unsupervised usage of metronidazole. Only 10 of 18 patients (56%) were considered compliant in their usage of metronidazole. These 10 patients experienced a significantly greater benefit from the metronidazole than did the 8 patients who were considered noncompliant, i.e., a reduction of surgical needs of 8.3 teeth per compliant patient versus 3.6 teeth per non-compliant patient. A test for the hydrolysis of the synthetic peptide (BANA) was also able to identify most non-compliant patients. Clinical trials involving the unsupervised usage of systemic medication need to take into account patient non-compliance.
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Affiliation(s)
- W J Loesche
- University of Michigan School of Dentistry, Ann Arbor 48109-1078
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31
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Liew V, Mack G, Tseng P, Cvejic M, Hayden M, Buchanan N. Single-dose concentrations of tinidazole in gingival crevicular fluid, serum, and gingival tissue in adults with periodontitis. J Dent Res 1991; 70:910-2. [PMID: 2022773 DOI: 10.1177/00220345910700050901] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Previous studies have shown that metronidazole is effective in the treatment of subgingival microflora associated with destructive periodontitis. The aim of this study was to determine whether tinidazole, a close analogue of metronidazole, would reach sufficient concentrations in serum, gingival crevicular fluid, and gingival tissue, to inhibit putative periodontopathic bacteria. Ten adult patients with moderate to advanced periodontitis took a single 2-g dose of tinidazole orally. Samples were assayed by high-performance liquid chromatography. The concentrations of tinidazole in serum and GCF were in a similar range (3.2-46.5 micrograms/mL). Tinidazole was not detected in the GCF in three of the patients. The drug was found in gingival tissue obtained at two h (0.17 +/- 0.14 micrograms/mg) and six h (0.15 +/- 0.18 micrograms/mg) after oral administration. The mean concentration of tinidazole in serum at 24 h (13 +/- 3.0 micrograms/mL) is greater than the minimum inhibitory concentration for anaerobic bacteria as reported by others. The present data suggest that a single 2-g oral dose of tinidazole may lead to the presence of potentially bactericidal levels of tinidazole for up to 24 h in the periodontal pockets of some patients with periodontitis.
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Affiliation(s)
- V Liew
- Periodontics Unit, Westmead Hospital Dental Clinical School, NSW, Australia
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32
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Abstract
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.
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Affiliation(s)
- J Slots
- Department of Periodontics, University of Pennsylvania, School of Dental Medicine, Philadelphia
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Chraïbi DI, Girond S, Michel G. Evaluation of the activity of four antimicrobial agents using an in vitro rapid micromethod against oral streptococci and various bacterial strains implicated in periodontitis. J Periodontal Res 1990; 25:201-6. [PMID: 2142728 DOI: 10.1111/j.1600-0765.1990.tb00905.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The activity of various antibacterial agents (amoxicillin, josamycin, doxycycline and metronidazole) was established in vitro using a rapid micromethod. The activity of these agents, which are widely used in oral medicine, was evaluated against microorganisms responsible for periodontitis and bucco-dental infections. Their action against alpha-hemolytic streptococci (including pneumococci) which make up the majority of the indigenous oral flora was also tested. Amoxicillin was found to be effective against all the strains tested. Doxycycline was active against periodontal bacteria, but not against 50% of the streptococcal flora. Josamycin was found to be effective against streptococci, but appeared without effect on Eikenella corrodens and Actinobacillus actinomycetemcomitans. Metronidazole, inactive against streptococci, displayed greater activity towards the strict anaerobes. The use of these antibiotics for the treatment of bucco-dental infections, especially periodontitis, is discussed. For periodontitis and periodontal suppurations, antimicrobial agents present a valuable adjunct to local treatments such as scaling or rootplaning. This may prevent more serious infections such as endocarditis that can develop after tooth extraction.
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Affiliation(s)
- D I Chraïbi
- Laboratoire de Microbiologie Industrielle et Virologie, Faculté des Sciences Pharmaceutiques, Toulouse, France
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34
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Loesche WJ. Rationale for the use of antimicrobial agents in periodontal disease. Int J Technol Assess Health Care 1990; 6:403-17. [PMID: 2228456 DOI: 10.1017/s026646230000101x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The traditional approach to treating dental decay and periodontal disease has often focused on caries, neglecting periodontal infection. The past 15 years have seen significant advances in the treatment of periodontal disease with antimicrobial therapy, both with and without more traditional debridement or surgery. This article presents an overview of the use of antimicrobials, including an examination of treatment philosophies and the diagnosis of periodontal infection.
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35
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Bower RC. Current concepts of periodontal maintenance. Aust Dent J 1989; 34:507-16. [PMID: 2695024 DOI: 10.1111/j.1834-7819.1989.tb04656.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Changing concepts and a more complete understanding of the aetiology of chronic marginal periodontitis allow a more rational approach to the treatment of patients with periodontal diseases. A sequence of treatment steps of increasing complexity is presented for the prevention of recurrence of chronic marginal periodontitis during the maintenance phase of treatment.
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36
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Jousimies-Somer H, Asikainen S, Suomala P, Summanen P. Activity of metronidazole and its hydroxy metabolite against clinical isolates of Actinobacillus actinomycetemcomitans. ORAL MICROBIOLOGY AND IMMUNOLOGY 1988; 3:32-4. [PMID: 3268747 DOI: 10.1111/j.1399-302x.1988.tb00602.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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37
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Fiehn NE. Susceptibility of small-sized oral spirochetes to eight antibiotics and chlorhexidine. ACTA PATHOLOGICA, MICROBIOLOGICA, ET IMMUNOLOGICA SCANDINAVICA. SECTION B, MICROBIOLOGY 1987; 95:325-9. [PMID: 3439461 DOI: 10.1111/j.1699-0463.1987.tb03133.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The purpose of the study was to examine the susceptibility of two different small-sized spirochete morphotypes from subgingival plaque to eight antibiotics and chlorhexidine. MIC-values were determined by a broth dilution method and related to achievable antibiotic tissue- and blood concentrations. The spirochetes were characterized as susceptible, moderate susceptible, and resistant to the different antibiotics. The MICs of tetracycline hydrochloride, doxycycline, penicillin G, and chlorhexidine were all considerably lower for spirochete strains with a 2:4:2 endoflagella system (two endoflagella from each cell-end) than for strains with a 1:2:1 endoflagella system (one endoflagellum from each cell-end). No differences were observed for the remaining antibiotics. Spirochetes containing one endoflagellum from each cell-end were found to be susceptible to metronidazole and doxycycline, susceptible to moderate susceptible to tetracycline hydrochloride, moderate susceptible to penicillin G, and resistant to the remaining antibiotics. Spirochetes containing two endoflagella from each cell-end were susceptible to doxycycline, tetracycline hydrochloride, and metronidazole. Susceptible to moderate susceptible to penicillin G. These spirochetes were resistant to the remaining agents. The significance of these observations is discussed in relation to obtainable gingival crevicular fluid concentrations and treatment of marginal periodontitis.
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Affiliation(s)
- N E Fiehn
- Department of Microbiology, Royal Dental College, Copenhagen, Denmark
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38
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Quee TC, Chan EC, Clark C, Lautar-Lemay C, Bergeron MJ, Bourgouin J, Stamm J. The role of adjunctive Rodogyl therapy in the treatment of advanced periodontal disease. A longitudinal clinical and microbiologic study. J Periodontol 1987; 58:594-601. [PMID: 3309251 DOI: 10.1902/jop.1987.58.9.594] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Several studies have indicated that the combination of metronidazole and spiramycin is synergistic against anaerobic bacteria and may be effective against oral infections. The present study sought to determine the efficacy and safety of a commercial preparation of these two antibiotics (Rodogyl) when used adjunctively in the treatment of advanced periodontal disease. In a double-blind parallel randomized trial, 56 patients (mean age = 44 years) with advanced periodontitis (50 of whom completed the study) were assigned to either the Rodogyl or placebo group. Both groups were thoroughly scaled and root planned for approximately 6 hours, with one group receiving Rodogyl for 2 weeks and the other a placebo. No other therapy was received during the study period. Two sites in each patient with probing depths of at least 7 mm were selected for study. Plaque level (P1I), gingival inflammation (GI), probing depth (PD), and attachment level (AL) were measured at baseline, 14 days, 1 month, and then at monthly intervals up to 6 months. Subgingival bacteria were monitored with dark-field microscopy. The development of resistant bacteria, as well as side effects to the medications, was also monitored. The Rodogyl group exhibited a greater gain in AL (0.67 mm) from the 2-month interval until the end of the study. Although this difference was statistically significant (P less than 0.05), it was not necessarily of biologic significance. There was a significantly greater decline in the proportion of spirochetes in the Rodogyl group at the 14-day interval, and this difference remained significant (P less than 0.05) at all study intervals. No difference in the proportion of motile organisms was observed.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- T C Quee
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
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Van Oosten MA, Notten FJ, Mikx FH. Metronidazole concentrations in human plasma, saliva, and gingival crevice fluid after a single dose. J Dent Res 1986; 65:1420-3. [PMID: 3097094 DOI: 10.1177/00220345860650120801] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Metronidazole concentrations were estimated in four human volunteers after a single dose of 750 mg taken orally. Samples of blood, saliva, and gingival crevice fluid were collected before intake and during the following 24 hours. The concentrations of metronidazole in plasma and saliva were measured by high-performance liquid chromatography (HPLC). The concentrations in gingival fluid were estimated by a capillary agar-diffusion assay. The results of the metronidazole measurements as obtained by both methods were significantly correlated. The peak concentrations of metronidazole in plasma and saliva were in the same range, 8.7-13.8 micrograms/mL, and similar concentrations were found in the gingival fluid samples. It is concluded that metronidazole taken orally has similar pharmacokinetics in both saliva and plasma, and that a single oral dose of 750 mg metronidazole leads to a concentration of the drug in the gingival crevice fluid that exceeds the minimal inhibitory concentration for most anaerobic oral micro-organisms.
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