¶ … Role of Antibiotic Therapy in the Treatment of Periodontal Disease?
The objective of this work is to examine the role of antibiotic therapy in the treatment of periodontal disease. Also examined will be the delivery system, the type of antibiotics and efficacy as an adjunct to mechanical therapy in the management of periodontal disease. Toward this end, this work will examine the literature in this area of study including literature located in professional and academic journal and publications.
Sub-Antimicrobial Dose Doxycycline
The work of Preshaw, et al. (2005) entitled "Long-Term Treatment with Sub-Antimicrobial Dose Doxycycline Has No Antibacterial Effect on Intestinal Flora" reports a study that sought to determine if a nine-month regimen of subantimicrobial doxycycline (20 mg. bid) had an effect on either the intestinal or the vaginal microflora. The study involved 69 individuals with periodontal disease who were randomized to receive drug or placebo control for a nine-month period. It is reported that stool specimens and vaginal swabs were collected at baseline and after three and nine months of therapy. Samples were examined for total anaerobic counts, opportunistic pathogens, and doxycycline-resistant bacteria. It is reported that "{all isolates that survived sub-culture were identified and their susceptibilities determined to six antibiotics." Preshaw et al. states "Substantial evidence indicates that the adjunctive use of sub-antimicrobial dose doxycycline (SDD) consisting of 20mg doxycycline hyclate (Periostatt, CollaGenex Pharmaceuticals Inc., Newtown, PA, USA), bid, provides a significant benefit to scaling and root planning (SRP) in the treatment of periodontitis because of the anticollagenase and anti-inflammatory activities of doxycycline. However, serious concern has been expressed that even sub-antimicrobial levels of doxycycline may exert a detrimental antimicrobial effect on the normal flora." (Preshaw, et al., 2005) It is reported that this effect might result in "…the disruption or suppression of the normal flora and lead to its colonization or overgrowth by opportunistic pathogens as well as the development of non-susceptible microorganisms." (Preshaw, et al., 2005) The study reported by Preshaw et al. states findings as follows: "Therefore, we concluded that the level of doxycycline present in the intestines was too low to promote or stimulate resistance. The trend detected in the number of doxycycline-resistant bacteria at 3 months is believed to be because of the initial imbalance present prior to drug administration and possibly to microbial variation because of dietary changes or to microbial sampling. As no differences between treatment groups were detected at 3 months in the predominant taxa recovered or in the MICs obtained, it was concluded that the trend observed at 3 months was not drug related." (Preshaw, et al., 2005)
II. Utilization of Locally Delivered Doxycycline in Non-Surgical Periodontitis Treatment
The work of Wennstrom (2001) entitled "Utilization of Locally Delivered Doxycycline in Non-Surgical Treatment of Chronic Periodontitis" reports a six-month multicenter trial in which two different approaches to non-surgical treatment of chronic periodontitis were examined through use of delivery of controlled -- release doxycycline for evaluation. The study involved 105 adult patients with moderately advanced chronic periodontitis form three participating centers in the trial. The study report states that each patient was required to "… present with at least 8 periodontal sites in 2 jaw quadrants with a probing pocket depth (PPD) of >5 mm and bleeding following pocket probing (BoP), out of which at least 2 sites had to be >7 mm and a further 2 sites >6 mm. Following a baseline examination, including assessments of plaque, PPD, clinical attachment level (CAL) and BoP, careful instruction in oral hygiene was given." (Wennstrom, 2001) Patients were assigned randomly to one of two treatment groups stated to be those of: (1) scaling/root planing (SRP) with local analgesia; or (2) debridement (supra- and subgingival ultrasonic instrumentation without analgesia)." (Wennstrom, 2001) It is reported that the "SRP" group "…received a single episode of full-mouth supra-/subgingival scaling and root planing under local analgesia. In addition, at a 3-month recall visit, a full-mouth supra-/subgingival debridement using ultrasonic instrumentation was provided. This was followed by subgingival application of an 8.5% w/w doxycycline polymer at sites with a remaining PPD of >5 mm." (Wennstrom, 2001) The study also reports that the debridement patient group was "initially subjected to a 45-minute full-mouth debridement with the use of an ultrasonic instrument and without administration of local analgesia, and followed by application of doxycycline in sites...
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