Comparison of Systemic Flurithromycin Therapy and Clinical Procedures in the Treatment of Periodontal Diseases

The purpose of the present investigation was to evaluate, in 20 periodontal patients, the microbial and clinical effects of flurithromycin therapy plus scaling and root planning (SRP) in comparison with SRP alone. Clinical assessments of plaque, bleeding on probing and pocket depth were made prior to SRP alone and SRP plus flurithromycin therapy (375 mg twice daily for 5 days) and after both treatments. Subgingival plaque samples (n. 180) were taken prior to and after both treatments and analyzed by conventional bacteriological procedures. Differences in pocket depth and prevalence of bacterial species were analyzed pre- and post-therapies using statistical analyses. A significant decrease (p<0.001) was seen for pocket depth post SRP alone and post SRP plus flurithromycin. After two treatments, Actinobacillus actinomycetemcomitans, Bacteroides forsythus and Prevotella melaninogenica were eradicated from all tested sites. If we compare the prevalence of the species isolated after SRP alone and after SRP plus flurithromycin statistically significant differences were detected for P. gingivalis and for Fusobacterium nucleatum (p<0.05 and p<0.01, respectively). Flurithromycin can be considered a useful adjunct to mechanical periodontal treatment since it is more efficient in eliminating periodontal pathogens.

Antibacterial activity of medicinal plant extracts against periodontopathic bacteria

This study was performed to evaluate the antibacterial activity of Althaea officinalis L. roots, Arnica montana L. flowers, Calendula officinalis L. flowers, Hamamelis virginiana L. leaves, Illicium verum Hook. fruits and Melissa officinalis L. leaves, against anaerobic and facultative aerobic periodontal bacteria: Porphyromonas gingivalis, Prevotella spp., Fusobacterium nucleatum, Capnocytophaga gingivalis, Veilonella parvula, Eikenella corrodens, Peptostreptococcus micros and Actinomyces odontolyticus. The methanol extracts of H. virginiana and A. montana and, to a lesser extent, A. officinalis were shown to possess an inhibiting activity (MIC < or = 2048 mg/L) against many of the species tested. In comparison, M. officinalis and C. officinalis extracts had a lower inhibiting activity (MIC > or = 2048 mg/L) against all the tested species with the exception of Prevotella sp. Illicium verum methanol extract was not very active though it had a particular good activity against E. corrodens. The results suggest the use of the alcohol extracts of H. virginiana, A. montana and A. officinalis for topical medications in periodontal prophylactics.

Antibacterial activity of moxifloxacin against periodontal anaerobic pathogens involved in systemic infections

The in vitro activity of moxifloxacin was compared with that of penicillin G, amoxycillin/clavulanate, cefoxitin, erythromycin, clindamycin and metronidazole against 158 isolates associated with periodontal infections. MIC(50)/MIC(90) values of moxifloxacin were respectively 0.06/0.5 mg/l for Porphyromonas gingivalis (35), for Prevotella spp. (28) and Actinomyces spp. (35), 0.12/0.25 mg/l for Fusobacterium nucleatum (20) and 0.06/0.12 mg/l for Peptostreptococcus spp. (30). The minimum inhibitory concentration (MIC) range of moxifloxacin for Bacteroides forsythus (6) and Campylobacter rectus (4) was 0.06-0.12 mg/l. The minimum bactericidal concentrations were equal to or 2-4 times the MIC values. Moxifloxacin produced a bactericidal effect at 8 h. Our results show that moxifloxacin has good antibacterial activity against periodontal pathogens comparable with that of cefoxitin and amoxycillin/clavulanate, and better than that of clindamycin, metronidazole and penicillin.

Antibacterial activity and post-antibiotic effect of flurithromycin compared with other macrolides and penicillins against periodontal pathogens

In this study the authors examined the activity of flurithromycin compared to that of erythromycin, spiramycin and penicillin against 107 strains of various species supposed to cause periodontitis. The range of MICs of flurithromycin was: < or =0.06-2 mg/l for P. gingivalis (28 isolates), 0.06-2 mg/l for P. melaninogenica (7), 0.5-4 mg/l for P. intermedia (5), 0.25-8 mg/l for Prevotella sp. (8), 1-16 mg/l for F. nucleatum (14), 0.12-0.5 mg/l for W. recta (2), 0.5-32 mg/l for E. corrodens, 0.5-2 mg/l for B. forsythus (2); < or =0.06-64 mg/l for Peptostreptococcus sp. (11), < or =0.06-1 mg/l for A. odontolyticus (11) and for A. naeslundii (7) and < or =0.06-16 mg/l for A. viscosus (7). Macrolide activity was ranked in decreasing order from flurithromycin to erythromycin to spiramycin. Beta-lactamase production was demonstrated in Prevotella sp. (20%) and in F. nucleatum (7%). Isolates which were beta-lactamase negative but resistant to penicillin were found among Peptostreptococcus sp. and Actinomyces sp. A post-antibiotic effect of 2 hours was seen for flurithromycin on P. gingivalis and E. corrodens. The good in vitro activity of flurithromycin against bacteria supposed to cause periodontitis suggests clinical potential in the treatment of these diseases.

Sub-MIC ciprofloxacin effect on fimbrial production by uropathogenic Escherichia coli strains

The urine from 210 patients with acute urinary tract infection (UTI) was examined to study the in vitro effect of ciprofloxacin on fimbriae production by uropathogenic Escherichia coli isolates. Forty-nine bacterial samples of density 10(5) CFU/ml were not considered. From the resulting 161 samples, E. coli was the major strain found, present in 54 samples. Other microoganisms found were: Enterococcus sp. (34 samples), Staphylococcus epidermis (22), yeasts (11), Proteus sp. (11), Pseudomonas sp. (11), Klebsiella sp. (8), Enterobacter sp. (6), Citrobacter sp. (3), and Acinetobacter sp. (1). The uropathogenic E. coli strains found were P-fimbriated, as demonstrated by hemoagglutination activity against human erythrocytes with and without mannose, SDS-PAGE of fimbrial proteins and transmission electron microscopy (TEM). All E. coli strains found were exposed in vitro to sub-inhibitory concentrations of ciprofloxacin (1/8 MIC). Our results showed that: 1) P-fimbriated E. coli is the most prevalent microorganism in acute UTI (34%); 2) exposure to sub-MICs of ciprofloxacin inhibits fimbrial production in 79% of E. coli strains; 3) the pattern of SDS-PAGE fimbrial proteins is modified after exposure; in particular, the most affected synthesis involves the protein at 18 kD known as P-fimbriae.

Porphyromonas gingivalis prevalence related to other micro-organisms in adult refractory periodontitis

Forty-six adult periodontal patients, selected on the basis of clinical examination, and 46 adult healthy subjects were examined. The subgingival plaque samples from one inflammatory and one non-inflammatory site of each periodontal patient were studied to determine Porphyromonas gingivalis prevalence related to other periodontal micro-organisms and to periodontal tissue destruction. The results showed Porphyromonas gingivalis as the main pathogenic micro-organism isolated in the inflammatory sites together with Bacteroides forsythus. Peptostreptococcus sp., Actinomyces sp. and Prevotella sp. were found as a normal oral flora in the healthy subjects. Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus and Eikenella corrodens were detected both in inflammatory and in non-inflammatory sites of periodontal patients as well as in the healthy subjects.

Isolation of Porphyromonas gingivalis and detection of immunoglobulin A specific to fimbrial antigen in gingival crevicular fluid

The present study evaluated the prevalence of Porphyromonas gingivalis and the correlation between the bacterial culture method and the detection of immunoglobulin A (IgA) specific to the P. gingivalis fimbrial antigen in gingival crevicular fluid (GCF). P. gingivalis was isolated from 78.3% of subgingival plaque samples obtained from active sites and 34.7% of those from inactive sites of periodontal patients. P. gingivalis was isolated from only 4.7% of healthy subjects (control group). Immunoglobulins specific to the P. gingivalis fimbrial antigen were detected by enzyme-linked immunosorbent assay (ELISA). The overall agreement between the results of the P. gingivalis culture method and the results of specific IgA detection in periodontal patients was 71.7% for active sites and 58.7% for inactive sites. IgA specific to P. gingivalis was absent in GCF from all of the sites of healthy subjects. The results suggest that P. gingivalis is associated with the local production of specific IgA. The detection of IgA antibodies specific to P. gingivalis in GCF by ELISA may be used as a predictive parameter to reveal the early phase of the activation of recurrent periodontal infections.

Antimicrobial interference of a subinhibitory concentration of azithromycin on fimbrial production of Porphyromonas gingivalis

The first pathogenic mechanism of Porphyromonas gingivalis, which is mainly responsible for adult periodontal diseases, is the attachment of fimbriae appendages to oral epithelial cells. The ability of a subinhibitory concentration of azithromycin to inhibit the expression of fimbriae in various strains of P. gingivalis isolated was investigated. A one-eighth subinhibitory concentration of azithromycin was evaluated in vitro. The antibiotic was active in 75% of P. gingivalis strains isolated, judged by both electrophoresis and transmission electron microscopy. The results indicate that the subinhibitory concentration of azithromycin is capable of blocking the pathogenic mechanism of P. gingivalis in vitro, and, therefore, can be used in vivo as a treatment for recurrent periodontitis.

The in vitro activity of trospectomycin against anaerobic bacteria

The authors evaluated the activity of trospectomycin, a new aminocyclitol which is characterized by good antibacterial and broad spectrum activity, in comparison with clindamycin and ampicillin on a sample of recent isolates: Bacteroides fragilis (15 strains), Bacteroides urealyticus (5 strains), Bacteroides vulgatus (5 strains), Bacteroides spp. (15 strains), Prevotella melaninogenica (6 strains), Porphyromonas asaccharolytica (7 strains), Mobiluncus spp. (3 strains), Peptococcus niger (3 strains), Peptococcus variabilis (9 strains), Peptococcus spp (30 strains), Peptostreptococcus anaerobius (5 strains), Peptostreptococcus asaccharolyticus (3 strains), Peptostreptococcus spp. (25 strains) and Propionibacterium spp. (7 strains). The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were determined for all strains by microtiter serial dilutions in Wilkins-Chalgren broth in an anaerobic chamber in an atmosphere of 10% H2, 10% CO2, 80% N2. All the drugs tested exert their activity against Gram-positive and Gram-negative anaerobic isolates. In particular, trospectomycin is quite active against Gram-positive cocci (MIC 90 = 4 - 8 mg/l), Gram-negative rods (MIC 90 = 8 - 16 mg/l), Gram-positive rods (MIC 90 = 4 mg/l) and Mobiluncus spp. (MIC 90 = 0.5 mg/l).

[A microbiological evaluation of the use of roxithromycin in oral odontogenic infections]

Odontogenic infections are the primary infections caused by indigenous oral bacteria, when a factor changes their perfect equilibrium. We studied 30 samples from patients with odontogenic infections that were submitted to therapy with roxithromycin. Our results showed that 79% of aerobic and 71% of anaerobic bacteria, responsible for odontogenic infections, were sensitive to roxithromycin.

Efficacy of azithromycin compared with spiramycin in the treatment of odontogenic infections

Sixty patients with acute odontogenic infections were randomly allocated to oral treatment with azithromycin 500 mg/day once-daily for three days (n = 30) or spiramycin 3,000,000 units three-times daily for seven days (n = 30). Baseline and post-treatment oral specimens were collected from patients to test for pathogenic bacteria. Aerobic bacteria were tested using the Kirby-Bauer disc diffusion method, and anaerobic bacteria with a broth microdilution method, for their susceptibility to azithromycin and spiramycin. A greater incidence of resistance was found in the spiramycin group than in the azithromycin group. The bacteriological assessment showed that the normal balance of microflora was re-established in 67% of patients treated with azithromycin vs 53% in the group treated with spiramycin. Clinical cure was higher in the azithromycin treatment group (97%) compared with the spiramycin group (73%). These results indicate that three-day azithromycin, possibly because of its unusual pharmacokinetics, is more effective than seven-day spiramycin in the treatment of odontogenic infections.

[Roxithromycin in dental infections]

Roxithromicin is a semisynthetic macrolide antibiotic, with similar antibacterial activity to erythromycin. It is characterized by an excellent pharmacokinetic profile and a good tissue penetration. Particularly at the dose of 300 mg per day the dental tissue diffusion is extremely good, and this is important to oppose the oral cavity infections. Oral cavity infections can be either odontogenic or non odontogenic. Odontogenic infections are typically primary and are caused by commensal bacteria (oral Streptococci, Bacteroides sp., Veillonella sp. and Fusobacterium sp.). The antibacterial spectrum of roxithromycin is very large and includes many of the most frequent strains responsible for oral cavity infections. A very interesting characteristic of roxithromycin is its penetration in macrophages (uptake) that allow a more rapid inhibition of bacterial activity. To evaluate the clinical efficacy and tolerance of roxithromycin in the treatment of odontogenic infections, an open study was performed. This study evaluated both the microbiological and clinical aspects. Thirty patients (21 females and 9 males) who had not been previously treated with antibiotic or antibacterial drugs, affected by infective dysodontiasis, gingivitis and periodontal diseases, received 300 mg per day (once a day) of roxithromycin for an average period of 6 days. The symptomatology considered was: intumescence, redness, pain, lymphangitis and presence of trismus. Clinical symptomatology was assessed at the start and at the end of the treatment. The symptomatological improvement due to roxithromycin was rapid and very effective. After 6 days of therapy, the improvement was statistically significant (p < 0.01) compared to basal conditions. No adverse reactions or side-effects were complained during the study. No changement were detected in laboratory parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

[The effect of Lactobacillus acidophilus and Bifidobacterium bifidum on the intestinal ecosystem of the elderly patient]

The authors have tested the therapeutic efficacy of a multibacterial combination consisting of Lactobacillus acidophilus (10(9)) and Bifidobacterium bifidum (10(9)) in elderly patients with bowel disorders. Bacteriological and histopathologic investigation showed this combination to yield excellent biologic results with restoration of duodenal bacterial flora and subsidence of clinical symptoms. The function of the muciparous glands was restored and the duodenal mucosa was normalized.

[Adhesion capacity of Enterococcus faecium (SF 68) and Enterococcus faecalis to various substrates]

The author's studied the adherence ability of Enterococcus faecium SF 68 compared to that of Enterococcus faecalis IM 11f, on various substrates: vascular catheters and cardiac valves of rabbit, immunodepressed rats and diabetic rats. The bacterial adherence test was calculated by the number of bacteria adhered for microscopic field enlarged to 2000. The data obtained by scanning electron microscope SEM (Cambridge Stereoscan 150 MK2) revealed a different adherence action of the two germs on the various substrates. All the adherence tests showed a higher and uniform adherence activity of E. faecalis compared to that of E. faecium.

[The interference of miocamycin on the adhesiveness and coaggregation of the bacteria responsible for periodontopathies]

The authors studied the effect miocamycin has on the adherence and coaggregation of pathogenic bacteria in periodontopathy. The data obtained by optic microscopy, after treatment of the strains with doses of miocamycin equal to 1/4 and 1/8 of the MIC after 3 and 6 hours, shows the interference effect on the coaggregation and adhesivity of the antibiotic. These results have been confirmed by the observations obtained by scanning electron microscope (SEM).

[Effect of spiramycin on the interbacterial aggregation process in dental plaque formation]

The Authors valued on 18 periodontal patients the bleeding, probing depth, plaque indexes before and after antibiotic therapy with spiramycin. After bacteriological test and coaggregation test the Authors concluded spiramycin all day long is endowed with a good activity in periodontal diseases.

Microbiological study of Enterococcus faecium SF68: post-antibiotic effect and growth curves

We studied the microbiological characteristics of Enterococcus faecium SF 68 (an oral vaccine) assessing post-antibiotic effect of ampicillin and growth curves in different media. Results showed a good resistance of the microorganism tested which has important implications in clinical practice. The growth ability of Enterococcus faecium SF 68 was similar on all media tested.

[Competitive activity of a bacterial preparation on colonization and pathogenicity of C. pylori. A clinical study]

The authors studied the ability of a live polymicrobial formulation containing Lactobacillus acidophilus 10(9) and Bifidobacterium bifidum 10(9) to act as an "ecological" therapy for gastritis and duodenitis. The study was carried out in volunteers suffering from these disorders which nowadays are attributed to C. pylori. The results obtained confirm previous findings in experimental animals. The polymicrobial formulation was found to be able to compete effectively with the microorganism responsible for the disorders and to improve the results obtained by traditional therapy.

[Interference of clindamycin in skin infection in rabbits caused by suture threads infected with slime-producing S. epidermidis]

The authors have carried out an experimental study to evaluate the interference of sub-inhibitory concentrations of clindamycin on the adherence of slime producing S. epidermidis to surgical nets and its ability to infect rabbits. 80 rabbits divided into 4 groups, (A, B, C, and D), underwent sham operation of the abdominal zone and were sewn up with sterile nets, infected nets and sub MIC of clindamycin equal to 1/8 MIC, respectively. The results obtained stressed a different survival rate 12 days after operation: 95% in group A, 35% in group B; 100% in group C and 95% in group D. This data were confirmed by the results obtained using MES (Cambridge Stereosecan 150 KM2). From our research an excellent clindamycin inhibitory activity on the pathogenicity of slime producing staphylococci emerged.

Effect of clindamycin on adherence of coagulase-negative Staphylococcus to surgical nets

The authors studied the effect that a subinhibitory concentration of Clindamycin has on adherence of coagulase negative S. epidermidis to surgical nets. Clindamycin, as expected, interferes with the adhesivity to the nets of coagulase-negative S. epidermidis slime producing when sub-MICs are used. The documentation obtained by scanning electron microscope, after treatment of the strains with doses of Clindamycin equal to 1/6 of the MIC after 3 and 6 hours, confirms the anti-adherent effect of the antibiotic.

[Immunogenic activity of a polyvalent oral vaccine]

The AA. studied the effects of a polyvalent oral vaccine on the cellular immunity, and on IgA level in animal. They also studied its ability to reactivate the response to the Clostridium tetani toxin in human volunteers. The results show a very good ability of the vaccine as specific and aspecific stimulator.

[Protection of an oral vaccine against experimental infection of mice and its role combined with the administration of penicillin]

The AA. studied the immunologic profile of an oral vaccine to prevent the experimental infection in mice and its effect when it was administered with antibiotic. The mice were infected with Staphylococcus aureus and protected by the vaccine administration. Our results confirmed the higher survival in the group that used this combination. The observed mortality was lower in group of mice treated with vaccine and penicillin combination, than in the untreated group.

[Immunologic characteristics of a polyvalent vaccine]

A lot of bacterial vaccines show a very interesting immunostimulating profile. The AA. studied the effects of a polyvalent vaccine on the phagocytosis, on the cellular immunity and on the IgA production. They also investigated its capacity to reactivate the response to the C tetani toxin (Booster effect), both "in vitro" and in human volunteers. The results show a significant improvement in the immunity response to specific and aspecific stimuli.

[The intestinal ecosystem of mice after administration of a polyvalent oral vaccine]

Bacterial antigens orally administered, have been showed by many Authors capable to stimulate immunity system, hinding thus the pathogen flora from gut-colonization. Founding on these findings, AA. of the present paper intend to point out by collected microbial data and M.E.S. photos, the activity of an oral polyvalent vaccine made by lysates strains of E.coli, enterococci, staphylococci and P.vulgaris, on normal intestinal flora of mice contemporaneously administered with a pathogenic strain of Salmonella enteritidis. Vaccine showed himself to be able enough to limit alterations of intestinal flora due to infection by the pathogens.

Microbiological basis for the use of fosfomycin trometamol as single-dose therapy for simple cystitis

Fosfomycin trometamol (FOT), a new soluble salt of fosfomycin, was developed especially for single-dose treatment in uncomplicated urinary tract infections. In this study, the minimum inhibitory concentrations (MICs) of FOT were measured both in nutrient broth and human urine and compared with calcium fosfomycin, pipemidic acid and cotrimoxazole. A total of 300 bacterial strains of different species from recent urinary infections were studied. Staphylococcus aureus showed the lowest MIC (0.38 micrograms/ml) and Pseudomonas spp. the highest (50 micrograms/ml) with fosfomycin salts in nutrient broth. The MIC of fosfomycin resulted in being higher than those for pipemidic acid and cotrimoxazole against Escherichia coli and Proteus rettgeri and lower for all the other species considered. The MIC values increased about ten times when urine was used as medium. No differences were observed between the two fosfomycin salts. The fosfomycin concentrations of 137-1500 micrograms/ml, easily obtained in urine of healthy adult subjects after a single dose of FOT (3g of fosfomycin), were able to kill all the strains, with the exception of Streptococcus faecalis. The bacterial adhesion of a resistant microorganism (P. aeruginosa) to the cells of the urinary tract, showed a 50% reduction after FOT treatment.

[Bactericidal and potent antiadhesive activity of sulbenicillin]

Sulbenicillin, a wide broad spectrum penicillin, is active against a lot of gram positive and gram negative bacteria. The AA. studied the activity of this molecule against urinary infections causing germs, by evaluating two parameters: his antiadhesive capability and the Killing curves, in comparison with mezlocillin and piperacillin. An inhibition in adhesive capability of test-germs, due to sulbenicillin was obtained. Furthermore, resulting Killing curves showed more rapidity in action for sulbenicillin than for the two others molecules, versus resistant germs, like P. aeruginosa and S. faecalis.

In vitro comparative study of RU 28965 against organisms from oral and vaginal flora

The Authors studied the activity of RU 28965, a new macrolide antibiotic, in comparison whith erytromycin, josamycin, miocamycin, ampicillin and rifampicin against oral streptococci (45 strains), coryneform bacteria (23 strains) and G. vaginalis (15 strains). Minimum inhibitory concentrations (MIC), minimum bactericidal concentrations (MBC) and the effect of inoculum size on MICs were determined. RU 28965 showed better activity than the other macrolides. The MICs of RU 28965 were eightfold higher than the corresponding MICs. The MICs of RU 28965 showed up to 10 fold increase by increasing the inoculum density from 10(3) to 10(7) CFU/ml.