amoxicillin-potassium-clavulanate-combination and Dental-Plaque

The aim of the present study was to investigate the clinical and microbiological effects of initial periodontal therapy in conjunction with systemic amoxicillin plus clavulanic acid in adult periodontitis patients using a double-blind, parallel-group, and placebo-controlled protocol. 21 patients with a clinical diagnosis of generalised adult periodontitis were recruited. Clinical measurements and microbiological assessments were carried out at baseline, 3, and 12 months post-treatment. Approximately 6 weeks after initial periodontal treatment (3-6 h), patients were randomly assigned to receive coded study medication of 500 mg amoxicillin plus 125 mg clavulanic acid (Augmentin) or placebo, every 8 h for 10 days. Patients returned for follow-up visits 3, 6, 9, and 12 months after completion of the medication. The mean plaque index (PI) at baseline was 1.1 for placebo group and 0.9 for the test group. At 3 months, the PI had dropped to 0.3 in both groups, and was maintained during the rest of the study. The changes in bleeding on probing (BOP) and gingival index (GI) in the course of the study were similar in both groups. The mean whole mouth probing pocket depth (PPD) in the placebo group was 3.8 mm at baseline and 3.9 mm in the test group. A mean reduction of 1.0 mm in the placebo group and 0.9 mm in the test group was observed during the first 3 months. No further reduction in PPD was noticed during the study period in either group. There was no statistically significant difference in the PPD reduction between the 2 groups. The change in clinical attachment level (CAL) from baseline to 3 months amounted to 0.5 mm in both groups. Between 3 and 12 months, the CAL changed in neither group. In both groups, treatment resulted in a decrease in the number of spirochetes and motile rods in positive patients, but no significant differences between either group were noted in any of the dark field microscopy observations. At baseline, 1 patient in the placebo group and 2 patients in the test group were culture positive for Actinobacillus actinomycetemcomitans (Aa). After therapy, Aa was not detectable in the placebo group and 1 patient remained positive in the test group. In the placebo group, the number of patients positive for Porphyromonas gingivalis (Pg) decreased from 7 to 2 after therapy. In the test group, the 4 patients positive for Pg at baseline remained positive after therapy. In both groups, all subjects were positive for Prevotella intermedia (Pi) and F

Topics: Adult; Aged; Aggregatibacter actinomycetemcomitans; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteria; Colony Count, Microbial; Dental Plaque; Dental Plaque Index; Double-Blind Method; Drug Therapy, Combination; Female; Follow-Up Studies; Gingival Hemorrhage; Humans; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Periodontitis; Placebos; Porphyromonas gingivalis; Prevotella intermedia; Spirochaetales

The purpose of the present investigation was to assess the effects of periodontal surgery and 4 systemically administered agents, Augmentin, tetracycline, ibuprofen or a placebo on clinical and microbiological parameters of periodontal disease. 98 subjects were monitored at 2-month intervals at 6 sites per tooth for clinical parameters. Subgingival plaque samples were taken from the mesial surface of each tooth at each visit and evaluated for their content of 14 subgingival species using DNA probes and a colony lift method. 40 subjects who exhibited loss of attachment > 2.5 mm at 1 or more sites during longitudinal monitoring were treated using modified Widman flap surgery at sites with probing pocket depth > 4 mm, subgingival scaling at all other sites and were randomly assigned 1 of the 4 agents. Treatment was completed within 30 days during which time the subject took the assigned agent. Overall, subjects exhibited a mean attachment level "gain" of 0.34 +/- 0.10 mm (SEM) and a mean pocket depth reduction of 0.62 +/- 0.09 mm 10 +/- 4 months post-therapy. However, certain subjects in each treatment group showed a poor response. Subjects receiving antibiotics exhibited significantly more attachment level "gain" (0.57 +/- 0.15 mm, SEM) than subjects receiving either ibuprofen or a placebo (0.02 +/- 0.10). The differences between Augmentin and tetracycline groups were not significant, nor were the differences between ibuprofen and placebo. 10 months post-therapy, there was a reduction in the number of sites colonized in any subject group by detectable levels (10(3)) of P. gingivalis. Species showing similar reductions were B. forsythus, P. intermedia and P. micros. Subjects receiving systemically administered antibiotics had a significant increase in the proportion of sites colonized by C. ochracea coupled with a greater decrease in the number of sites colonized by P. gingivalis, B. forsythus, P. intermedia and P. micros post-therapy than subjects not receiving antibiotics. The results of this investigation indicate that adjunctive systemic antibiotics increase periodontal attachment "gain" and decrease the levels of some suspected periodontal pathogens in subjects with evidence of current disease progression.

Topics: Adolescent; Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Bacterial Infections; Bacteroidaceae; Chemotherapy, Adjuvant; Clavulanic Acids; Dental Plaque; Dental Scaling; Disease Progression; Drug Therapy, Combination; Female; Humans; Ibuprofen; Longitudinal Studies; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Placebos; Subgingival Curettage; Surgical Flaps; Tetracycline

In a study of the efficacy of modified Widman flap surgery and scaling and root planning accompanied by 1 of 4 systemic adjunctive agents, Augmentin, tetracycline, ibuprofen or placebo, it was observed that subjects differed in their response to therapy. The difference was only partially accounted for by the adjunctive agent employed. The purpose of the present investigation was to examine clinical and microbiological features in subjects who showed different levels of attachment change post-therapy. 40 subjects were subset into 3 groups based on mean attachment level change post-therapy. 10 poor response subjects showed mean attachment loss; 19 moderate response subjects showed mean attachment gain between 0.02-0.5 mm and 11 good response subjects showed a mean gain of attachment > 0.5 mm. Clinical parameters were measured at 6 sites per tooth both pre- and post-therapy. Microbiological samples were taken from the mesial aspect of each tooth and evaluated individually for their content of 14 subgingival taxa using a colony lift method and DNA probes. % of sites colonized by each species was computed for each subject both pre- and post-therapy. Significant differences were observed among treatment response groups for mean probing pocket depth, attachment level and % of sites with plaque pre-therapy. The poor response subjects had the lowest mean probing pocket depth and attachment level, but the highest plaque levels. Post-therapy, the poor response group exhibited the greatest degree of gingival inflammation as assessed by gingival redness and bleeding on probing.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Bacteria; Chemotherapy, Adjuvant; Clavulanic Acids; Combined Modality Therapy; Dental Plaque; Dental Scaling; Drug Therapy, Combination; Gingival Hemorrhage; Gingivitis; Humans; Ibuprofen; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Placebos; Root Planing; Surgical Flaps; Tetracycline

Weak direct current (DC) exerts killing effect and synergistic killing effect with antibiotics in some specific bacteria biofilms. However, the potential of weak DC alone or combined with periodontal antibiotics in controlling periodontal pathogens and plaque biofilms remains unclear. The objective of this study was to investigate whether weak DC could exert the anti-biofilm effect or enhance the killing effect of metronidazole (MTZ) and/or amoxicillin-clavulanate potassium (AMC) on subgingival plaque biofilms, by constructing an in vitro subgingival plaque biofilm model.. The pooled subgingival plaque and saliva of patients with periodontitis (n = 10) were collected and cultured anaerobically on hydroxyapatite disks in vitro for 48 h to construct the subgingival plaque biofilm model. Then such models were stimulated with 0 μA DC alone (20 min/12 h), 1000 μA DC alone (20 min/12 h), 16 μg/ml MTZ, 16 μg/ml AMC or their combination, respectively. Through viable bacteria counting, metabolic activity assay, quantitative real-time PCR absolute quantification and 16S rDNA sequencing analysis, the anti-biofilm effect of 1000 μA DC and enhanced killing effects of 1000 μA DC combined with antibiotics (MTZ, AMC or MTZ+AMC) were explored.. The old subgingival plaque model (48 h) had no significant difference in total bacterial loads from subgingival plaque in situ, which achieved a similarity of 80%. The 1000 μA DC plus MTZ or AMC for 12 h showed a stronger synergistic killing effect than the same combination for 20 min. The metabolic activity was reduced to the lowest by DC plus MTZ+AMC, as 37.4% of that in the control group, while average synergistic killing effect reached 1.06 log units and average total bacterial loads decreased to 0.87 log units. Furthermore, the relative abundance of the genera Porphyromonas, Prevotella, Treponema_2, and Tannerella were decreased significantly.. The presence of weak DC (1000 μA) improved the killing effect of antibiotics on subgingival plaque biofilms, which might provide a novel strategy to reduce their antibiotic resistance.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Biofilms; Dental Plaque; Drug Resistance, Microbial; Humans; Metronidazole

Bacterial resistance to antibiotics is a health problem in many parts of the world. The aim of this study was to identify bacteria from dental infections and determine bacterial resistance to antibiotics used in dental care in the primary dentition.. This cross-sectional study comprised 60 children who presented for dental treatment for active dental infections in the primary dentition. Samples from dental infections were collected and bacteria were identified by polymerase chain reaction (PCR) assay. Bacterial resistance to antibiotics was determined by colony forming units on agar plates containing amoxicillin, clindamycin and amoxillicin-clavulanic acid (A-CA) tested at 8 μg/ml or 16 μg/ml.. Clindamycin in both concentrations tested (8 μg/ml and 16 μg/ml) showed the highest bacterial resistance (85.9%), followed by amoxicillin (43.7%) and A-CA (12.0%). All comparisons among the three antibiotics used in the study exhibited statistical significance (p = <0.05) in both concentrations tested (8 μg/ml and 16 μg/ml), and under aerobic and anaerobic conditions. The most prevalent resistant species identified by PCR in primary dentition infections were: Streptococcus oralis and Prevotella intermedia (75.0%); Treponema denticola and Porphyromonas gingivalis (48.3%); Streptococcus mutans (45.0%); Campylobacter rectus; and Streptococcus salivarius (40%).. This study demonstrated that A-CA exhibited the lowest bacterial resistance for clinical isolates in primary dentition infections.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; Biofilms; Child; Child, Preschool; Clindamycin; Colony Count, Microbial; Cross-Sectional Studies; Dental Plaque; Drug Resistance, Multiple, Bacterial; Humans; Tooth Diseases; Tooth, Deciduous

Enterococcus faecalis may contribute to periodontal breakdown in heavily infected subgingival sites, particularly in patients responding poorly to mechanical forms of periodontal therapy. Because only limited data are available on the antimicrobial sensitivity of enterococci of subgingival origin, this study evaluates the in vitro antibiotic susceptibility of E. faecalis isolated from periodontitis patients in the United States.. Pure cultures of 47 subgingival E. faecalis clinical isolates were each inoculated onto specially prepared broth microdilution susceptibility panels containing vancomycin, teicoplanin, and six oral antibiotics of potential use in periodontal therapy. After incubation in ambient air for 18 to 20 hours, minimal inhibitory drug concentrations were determined using applicable Clinical and Laboratory Standards Institute criteria and interpretative guidelines. The organisms were additionally evaluated for in vitro resistance to metronidazole at 4 μg/mL.. Periodontal E. faecalis exhibited substantial in vitro resistance to tetracycline (53.2% resistant), erythromycin (80.8% resistant or intermediate resistant), clindamycin (100% resistant to 2 μg/mL), and metronidazole (100% resistant to 4 μg/mL). In comparison, the clinical isolates were generally sensitive to ciprofloxacin (89.4% susceptible; 10.6% intermediate resistant) and 100% susceptible in vitro to ampicillin, amoxicillin/clavulanate, vancomycin, and teicoplanin.. Tetracycline, erythromycin, clindamycin, and metronidazole revealed poor in vitro activity against human subgingival E. faecalis clinical isolates, and would likely be ineffective therapeutic agents against these species in periodontal pockets. Among orally administered antibiotics, ampicillin, amoxicillin/clavulanate, and ciprofloxacin exhibited marked in vitro inhibitory activity against periodontal E. faecalis, and may be clinically useful in treatment of periodontal infections involving enterococci.

Topics: Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Bacteriological Techniques; Chronic Periodontitis; Ciprofloxacin; Clindamycin; Dental Plaque; Drug Resistance, Bacterial; Enterococcus faecalis; Erythromycin; Female; Gingiva; Gram-Positive Bacterial Infections; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Periodontal Pocket; Periodontitis; Teicoplanin; Tetracycline Resistance; Vancomycin

Beta-lactam antibiotics prescribed in periodontal therapy are vulnerable to degradation by bacterial β-lactamases. This study evaluated the occurrence of β-lactamase-positive subgingival bacteria in chronic periodontitis subjects of USA origin, and assessed their in vitro resistance to metronidazole at a breakpoint concentration of 4 μg/mL.. Subgingival plaque specimens from deep periodontal pockets with bleeding on probing were removed from 564 adults with severe chronic periodontitis before treatment. The samples were transported in VMGA III and then plated onto: (i) nonselective enriched Brucella blood agar (EBBA) and incubated anaerobically for 7 d; and (ii) selective trypticase soy-bacitracin-vancomycin (TSBV) and incubated for 3 d in air + 5% CO2 . At the end of the incubation periods, the bacterial test species were identified and quantified. Specimen dilutions were also plated onto EBBA plates supplemented with 2 μg/mL of amoxicillin, a combination of 2 μg/mL of amoxicillin plus 2 μg/mL of the β-lactamase inhibitor clavulanic acid, or 4 μg/mL of metronidazole, followed by anaerobic incubation for 7 d. Bacterial test species presumptively positive for β-lactamase production were identified by growth on EBBA primary isolation plates supplemented with amoxicillin alone and no growth on EBBA primary isolation plates containing both amoxicillin plus clavulanic acid. A subset of such isolates was subjected to nitrocefin-based chromogenic disk testing to confirm the presence of β-lactamase activity. In vitro resistance to 4 μg/mL of metronidazole was noted when growth of test species occurred on metronidazole-supplemented EBBA culture plates.. Two-hundred and ninety-four (52.1%) of the study subjects yielded β-lactamase-producing subgingival bacterial test species, with Prevotella intermedia/nigrescens, Fusobacterium nucleatum and other Prevotella species most frequently identified as β-lactamase-producing organisms. Of the β-lactamase-producing bacterial test species strains recovered, 98.9% were susceptible in vitro to metronidazole at 4 μg/mL.. The occurrence of β-lactamase-positive subgingival bacterial species in more than half of the subjects with severe chronic periodontitis raises questions about the therapeutic potential of single-drug regimens with β-lactam antibiotics in periodontal therapy. The in vitro effectiveness of metronidazole against nearly all recovered β-lactamase-producing subgingival bacterial species further supports clinical periodontitis treatment strategies involving the combination of systemic amoxicillin plus metronidazole.

Topics: Adult; Aged; Aged, 80 and over; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Bacteriological Techniques; beta-Lactamase Inhibitors; beta-Lactamases; Chronic Periodontitis; Dental Plaque; Drug Resistance, Bacterial; Enzyme Inhibitors; Female; Fusobacterium nucleatum; Gingiva; Gram-Negative Bacteria; Humans; Male; Metronidazole; Middle Aged; Periodontal Pocket; Prevotella; Prevotella intermedia; Prevotella nigrescens

Gram-negative enteric rods were associated with periodontal diseases in several populations. The association between enteric and putative periodontal pathogens has received little attention in the literature. The present investigation determined the occurrence and in vitro antimicrobial susceptibility of isolates of Gram-negative enteric rods from Colombian patients with chronic periodontitis.. Clinical parameters and the in vitro antimicrobial sensitivity of isolates of Gram-negative enteric rods were examined in 76 patients with chronic periodontitis in Medellin, Colombia. Subgingival samples were processed using culture and biochemical tests for the detection of periodontal and superinfecting pathogens. Selected colonies of Gram-negative enteric rods from pure cultures were used to test the susceptibility to amoxicillin/clavulanic acid, ciprofloxacin, and moxifloxacin. Chi-square and Mann-Whitney tests were used to determine differences in clinical variables versus the presence or absence of Gram-negative enteric rods.. Klebsiella pneumoniae was found in 12 patients, Pseudomonas aeruginosa was found in four patients, and three other species were recovered with a lower prevalence. Men (38.75%) tended to harbor more of the studied organisms than women (17.7%) (P = 0.04). Gram-negative enteric rods in periodontal pockets correlated positively with the presence of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis, and Prevotella intermedia/nigrescens (respectively, r = 0.66, 0.31, and 0.32; P <0.001). All superinfecting organisms demonstrated a high susceptibility to moxifloxacin and ciprofloxacin but exhibited a variable susceptibility to amoxicillin/clavulanic acid.. This study found high levels of Gram-negative enteric rods in patients with chronic periodontitis. Moxifloxacin and ciprofloxacin appeared capable of eradicating these organisms from periodontal pockets. Its good activity against Gram-negative enteric rods and periodontopathogens suggests the potential use of moxifloxacin as an adjunctive antibiotic in the treatment of mixed periodontal infections.

Topics: Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Aza Compounds; Chi-Square Distribution; Chronic Periodontitis; Ciprofloxacin; Colombia; Dental Plaque; Enterobacteriaceae; Female; Fluoroquinolones; Gram-Negative Facultatively Anaerobic Rods; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Moxifloxacin; Pseudomonas; Quinolines; Statistics, Nonparametric

The increasing rate of resistance of microorganisms to penicillin and other antibiotics has generated concern among health authorities in Latin America. The present investigation determined the in vitro susceptibility of Porphyromonas gingivalis, Fusobacterium nucleatum, black-pigmented Prevotella spp. and Aggregatibacter actinomycetemcomitans to metronidazole, amoxicillin, amoxicillin/clavulanic acid, clindamycin and moxifloxacin in patients with chronic periodontitis.. Subgingival plaque samples from patients with periodontitis were collected and cultured on selective and nonselective culture media. The antimicrobial susceptibility of periodontopathogenic isolates was studied in chronic periodontitis patients in Colombia. Metronidazole, amoxicillin, amoxicillin/clavulanic acid, clindamycin and moxifloxacin were tested on all bacterial isolates and the percentage of resistant strains was calculated.. Of the 150 bacteria identified, 51 were P. gingivalis, 45 were black-pigmented Prevotella spp., 36 were F. nucleatum and 18 were A. actinomycetemcomitans. All the isolates were sensitive to amoxicillin/clavulanic acid and to moxifloxacin, but exhibited variable susceptibility patterns to the other antimicrobial agents tested.. The results of the present study suggest that periodontal microorganisms in patients with chronic periodontitis can be resistant to the antimicrobial agents commonly used in anti-infective periodontal therapy. We suggest that the indiscriminate use of antimicrobials could result in the appearance of more highly antibiotic-resistant strains of bacteria associated with periodontal diseases in our population compared with the populations of other countries.

Topics: Adult; Aged; Aggregatibacter actinomycetemcomitans; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Ampicillin Resistance; Anti-Infective Agents; Aza Compounds; Bacteriological Techniques; beta-Lactam Resistance; Chronic Periodontitis; Clindamycin; Colombia; Dental Plaque; Drug Resistance, Bacterial; Female; Fluoroquinolones; Fusobacterium nucleatum; Gingival Hemorrhage; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Moxifloxacin; Periodontal Attachment Loss; Periodontal Pocket; Porphyromonas gingivalis; Prevotella; Quinolines

Generalized aggressive periodontitis (GAgP) encompasses a distinct type of periodontal disease exhibiting much more rapid periodontal tissue destruction than chronic periodontitis. The best method for management of GAgP may include the use of both regenerative periodontal techniques and the administration of systemic antibiotics.. The treatment of a case of GAgP over a period of 6.7 years is presented in this case report. Initial periodontal therapy (week 1- 32) consisted of supragingival plaque control and three appointments of scaling and root planing. Based on the periodontal pathogens isolated (5 species), the patient also received metronidazole plus amoxicillin for one week, followed 10 weeks later by metronidazole plus amoxicillin/clavulanate for one week. The patient was put on regular supportive periodontal therapy (SPT) thereafter. Orthodontic treatment was performed after completion of the initial therapy for 96 weeks. Measurements of clinical attachment level, bleeding on probing and plaque index were obtained at every examination.. Antimicrobial and mechanical treatment resulted in eradication of all periopathogens and significantly improved all clinical parameters. During orthodontic treatment and active maintenance, there was no relapse of GAgP. The patient participated in SPT for 194 weeks and thereafter decided to discontinue SPT. Twenty-four months later a relapse of GAgP was diagnosed and all teeth had to be extracted.. These results indicate that a combined mechanical and antimicrobial treatment approach can lead to consistent resolution of GAgP. Further studies including a larger number of cases are warranted to validate these findings.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Aggressive Periodontitis; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Bacteroides; Dental Plaque; Dental Plaque Index; Dental Scaling; Female; Follow-Up Studies; Humans; Malocclusion, Angle Class II; Metronidazole; Orthodontics, Corrective; Periodontal Attachment Loss; Periodontal Index; Porphyromonas gingivalis; Recurrence; Root Planing; Treatment Outcome

The purpose of this study was to utilize an in vitro biofilm model of subgingival plaque to investigate resistances in subgingival biofilm communities to antibiotics commonly used as adjuncts to periodontal therapy.. Biofilms were grown on saliva-coated hydroxyapatite supports in trypticase-soy broth for 4 h-10 days and then exposed for 48 h to either increasing twofold concentrations of tetracycline, amoxicillin, clindamycin, and erythromycin or therapeutically achievable concentrations of tetracycline, doxycycline, minocycline, amoxicillin, metronidazole, amoxicillin/clavulanate, and amoxicillin/metronidazole.. Concentrations necessary to inhibit bacterial strains in steady-state biofilms were up to 250 times greater than the concentrations needed to inhibit the same strains grown planktonically. In the presence of therapeutically available antibiotic concentrations, significantly higher proportions of the biofilms remained viable as the biofilms reached steady-state growth. The combinations of amoxicillin/clavulanate and amoxicillin/metronidazole were the most effective in suppressing growth. These combinations were particularly effective against biofilms up to and including 7 days of age and inhibited 90% or more of the bacteria present relative to untreated controls. As the biofilms approached steady state, these combinations were less effective with 50-60% of the bacteria retaining viability.. Most, but not all, species of subgingival bacteria are considerably more resistant in biofilms than in planktonic cultures. Resistance appeared to be age-related because biofilms demonstrated progressive antibiotic resistance as they matured with maximum resistance coinciding with the steady-state phase of biofilm growth.

Topics: Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Biofilms; Clindamycin; Dental Pellicle; Dental Plaque; Dose-Response Relationship, Drug; Doxycycline; Drug Resistance, Bacterial; Durapatite; Erythromycin; Gingiva; Gram-Negative Bacteria; Humans; Metronidazole; Middle Aged; Minocycline; Periodontitis; Tetracycline; Time Factors

This study assessed the extent of beta-lactamase-producing bacteria in subgingival plaque samples obtained from 25 patients with refractory marginal periodontitis in the USA. beta-Lactamase-positive isolates were characterized using commercial diagnostic kits and partial sequencing of the 16S rRNA gene. The susceptibilities to different antimicrobial agents were tested and, in addition, the isolates were screened for the presence of extended spectrum beta-lactamases (ESBLs). beta-lactamase-producing bacteria were detected in 18 (72%) patients. The most prominent beta-lactamase-producing organisms belonged to the anaerobic genus Prevotella. Other enzyme-producing anaerobic strains were Fusobacterium nucleatum, Propionibacterium acnes and Peptostreptococcus sp. Facultative bacteria, such as Burkholderia spp., Ralstonia pickettii, Capnocytophaga spp., Bacillus spp., Staphylococcus spp. and Neisseria sp., were also detected among the enzyme-producers. Minimum inhibitory concentrations (MICs) of ampicillin and amoxicillin were in the range 1.5-256 micrograms/ml and 4-256 micrograms/ml, respectively, for the isolates of the Prevotella species. All Prevotella isolates were susceptible to amoxicillin/clavulanate and metronidazole, but they showed variable resistance to tetracyclines. Two of the Prevotella isolates had high MICs of cefotaxime and ceftazidime. ESBL activity was not detected in any of the beta-lactamase-producing isolates by the Etest method. Thus, our study demonstrated a wide variety of beta-lactamase-producing bacteria that may play a role in refractory periodontal disease.

Topics: Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteria, Anaerobic; beta-Lactamases; Dental Plaque; Humans; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Periodontitis; Prevotella; Tetracyclines

The location of plaque-associated gingivitis at the gingival portion of the tooth plays an essential role in its genesis. However, at times local and other host response modifying factors also have an influence. The pathogeny of periodontitis is more complex. The microorganisms that comprise subgingival plaque are capable of acting directly on periodontal tissues or of modifying the host response, whereas the participation of the plaque per se (normal, decreased, or increased) is as decisive as the action of the bacteria themselves in the emergence of the disease. Different types of periodontitis are associated with specific microorganisms. The most periodontopathogenic are A. actinomycetemcomitans, P. gingivalis, and T. forsythensis. Periodontitis as a whole, represent the source of complications such as root caries, endoperiodontal processes and periodontal abscesses. They are associated with various illnesses such as atherosclerosis, diabetes, and respiratory infections, amongst others, as well as pathological oral halitosis. The different modalities of PCR are particularly important in the microbiological diagnosis of periodontitis, although on the negative side of things, it must be pointed out that in vitro sensitivity studies cannot be performed using this technique. First line antibiotic treatment of periodontitis includes amoxicillin/ clavulanic acid, metronidazole (associated or not with amoxicillin) and clindamycin.

Topics: Aggregatibacter actinomycetemcomitans; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Arteriosclerosis; Campylobacter rectus; Dental Plaque; Diabetes Complications; Fusobacterium; Humans; Periodontitis; Porphyromonas gingivalis; Prevotella; Treponema denticola

The hypothesis was tested that bacterial susceptibilities in aggressive periodontitis change upon administration of systemic antibiotics as adjuncts to periodontal therapy.. In 23 subjects (average age 38.9+/-6.7 years) with aggressive periodontitis, microbial parameters were assessed prior to and 1 year after completion of comprehensive mechanical/surgical and systemic antimicrobial therapy. Following identification of five selected pathogens with the Rapid ID 32 A system, their susceptibilities towards amoxicillin/clavulanate potassium, metronidazole, and tetracycline were examined with the E-test. Antibiotics were administered according to the test results, and the minimal inhibitory concentrations (MIC90) were reevaluated after 1 year. Statistical analysis was performed on a patient basis, with the site data used for evaluation of the MIC levels.. Bacterial MIC levels remained constant among the three antibiotic treatment groups compared with baseline. Mean MIC90 values ranged from <0.02 to 0.11 microg/ml (amoxicillin/clavulanate potassium), <0.02 to 0.27 microg/ml (metronidazole), and <0.02 to 0.11 microg/ml (tetracycline). Observed changes in susceptibility were attributed to the elimination of single bacterial taxa in the subgingival environment after antibiotic therapy. There were no statistically significant differences in clinical parameters among the treatment groups. Single tetracycline MICs were 1.5- to 6-fold enhanced compared to amoxicillin/clavulanate potassium and metronidazole.. The periodontal pathogens investigated prior to and 1 year after periodontal therapy are tested sensitive to the antimicrobial agents. In aggressive periodontitis, changes in bacterial susceptibility upon the administration of systemic antibiotics are associated with the limited number of isolates tested following therapy.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Combined Modality Therapy; Dental Plaque; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Follow-Up Studies; Gram-Negative Bacteria; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Periodontal Diseases; Periodontitis; Pilot Projects; Statistics, Nonparametric; Tetracycline

In the present study, the antibiotic susceptibility of most prevalent micro-organisms in advanced periodontitis patients was evaluated. In 56 patients, pooled subgingival plaque samples were taken from the deepest site of each quadrant and were cultivated anaerobically. From each patient, the 4 most frequently encountered types of bacterial colonies were subcultured and identified (Rapid ID 32 A). From all bacterial species identified in the 224 subcultures, the 4 most prevalent were used for susceptibility testing to tetracycline, metronidazole and amoxicillin/clavulanate using the E Test. The most prevalent microorganisms were Fusobacterium nucleatum (38/214), Peptostreptococcus micros (33/214), Prevotella oralis (33/214) and Porphyromonas gingivalis (32/214). Regarding antibiotic susceptibility it could be shown that minimal inhibitory concentration (MIC) in all cases was below antibiotic concentrations achievable in gingival crevicular fluid. However, antibiotic resistance was seen in 3 to 29% of the investigated microorganisms.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteria, Anaerobic; Biofilms; Dental Plaque; Drug Resistance, Microbial; Female; Fusobacterium nucleatum; Gingival Crevicular Fluid; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Peptostreptococcus; Periodontal Index; Periodontitis; Porphyromonas gingivalis; Prevotella; Tetracycline; Tetracycline Resistance

Prepubertal periodontitis affects both primary and permanent dentition. The purpose of this study was to examine the composition of subgingival microflora of the permanent dentition in an 11-year-old Caucasian female, who had premature exfoliation of her deciduous teeth on her 5th year of age, and the response of this condition to the antibiotic therapy and supportive periodontal care. Gingival tissues were highly inflamed and alveolar bone loss was detected radiographically. The girl had experienced frequent upper respiratory tract infections, tonsilitis and recurrent otitis media. Her mother had history of early onset periodontitis associated with chronic idiopathic neutropenia. Blood chemistry tests and immunological examinations were also performed. Subgingival plaque samples were collected from the proximal sites of permanent molars, incisors, canines and maxillary premolars. 27 different microbial species were isolated from the subgingival microflora. Among the predominant species were Porphyromonas gingivalis (17.6%-7.3%), Prevotella intermedia (12.4%-4.7%), Capnocytophaga sputigena (14.4%-10.4%), Capnocytophaga ochracea (13.2%-6.9%) and Actinobacillus actinomycetemcomitans (9.3%-5.5%). Periodontal treatment consisted of scaling, root planing in conjunction with antibiotic administration of Augmentin 312.5 mg and Flagyl 200 mg, each t.i.d. for 10 days. 3 weeks after the antibiotic therapy, bacterial samples were collected from the same sites. All the periodontal pathogens were recovered in lower levels and A.actinomycetemcomitans was almost eliminated in the 3-week period. The evaluation of clinical indices at 3, 6 and 12 months showed that periodontal treatment in conjunction with antibiotics was effective and rapidly followed by marked clinical improvement. The microbiological monitoring at 3, 6 and 12 months after antibiotic treatment and each time prior to supportive periodontal care, revealed that the periodontal pathogens fluctuated in low levels even 12 months after treatment and could be maintained at low level by supportive periodontal care at 3-month intervals.

Topics: Aggregatibacter actinomycetemcomitans; Aggressive Periodontitis; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteria; Capnocytophaga; Child; Chronic Disease; Dental Plaque; Dental Scaling; Drug Therapy, Combination; Female; Follow-Up Studies; Gingiva; Humans; Metronidazole; Neutropenia; Porphyromonas gingivalis; Prevotella intermedia; Root Planing

In 23 untreated adult periodontitis patients, the occurrence of beta-lactamase producing periodontal bacteria was determined. In addition to non-selective isolation media, selective isolation and growth of beta-lactamase positive subgingival bacterial species was carried out on blood agar plates supplemented with amoxicillin and plates with amoxicillin+clavulanic acid. Porphyromonas gingivalis, Prevotella intermedia, Actinobacillus actinomycetemcomitans, Peptostreptococcus micros, Fusobacterium nucleatum, Bacteroides forsythus and Campylobacter rectus isolates from the non-selective medium were tested for beta-lactamase activity by a nitrocefin disk method (DrySlide) and by a laboratory chromogenic nitrocefin-based test. Isolates from the amoxicillin plates that were absent on the amoxicillin/clavulanic acid plates were identified and tested for beta-lactamase production. Based on the non-selective plates, six of 23 P. intermedia isolates, 2 of 19 B. forsythus isolates and 3 of 23 F. nucleatum isolates were beta-lactamase positive. The beta-lactamase positive species Prevotella loescheii, Prevotella buccae, Prevotella buccalis and Actinomyces spp were recovered from the selective amoxicillin plates. beta-Lactamase positive subgingival species were recovered from 17 of 23 patients (74%) but usually comprised low proportions of the subgingival microbiota (range < 0.01-15%). Comparison of the DrySlide test and the nitrocefin-based laboratory test revealed full agreement of test results. beta-Lactamase activity in whole subgingival plaque was detected in 12 patient samples (52%). It was concluded that beta-lactamase activity in subgingival bacteria in adult periodontitis is a common feature. However, since the majority of the samples showed only low-level enzymatic activity, the clinical relevance of this observation with regard to therapy with unprotected enzyme-susceptible beta-lactams is uncertain, though failure on the other hand, is difficult to rule out when a mechanism of resistance is present. The majority of beta-lactamase positive strains was found among species of the Prevotella genus.

Topics: Actinomyces; Adult; Aggregatibacter actinomycetemcomitans; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteria; Bacteroides; beta-Lactamases; Campylobacter; Cephalosporins; Chromogenic Compounds; Clavulanic Acids; Culture Media; Dental Plaque; Fusobacterium nucleatum; Gingiva; Humans; Indicators and Reagents; Penicillins; Peptostreptococcus; Periodontitis; Porphyromonas gingivalis; Prevotella; Prevotella intermedia

The aim of this study was to examine the subgingival microflora associated with failing implants, and to determine their susceptibility to commonly used antibiotics in periodontal therapy and dental practice. Thirteen partially edentulous patients with 19 failing implants were selected. Clinical examination included probing depth, attachment level, gingival index, plaque index, and radiographic analyses. Two subgingival plaque samples were taken from each failing implant and analyzed for microbial composition. Fusobacterium nucleatum, Porphyromonas gingivalis, and Prevotella intermedia were the prevalent cultivable microflora. Antimicrobial susceptibility of isolates was determined by the agar dilution technique. Antibacterial activity of penicillin G, amoxicillin, amoxicillin-clavulanate, and the combination amoxicillin-metronidazole was significantly higher than with other antibiotics tested. These data indicated that the commonly-used antibiotics were highly effective against bacteria isolated around failing implants, which would suggest the use of these antibiotics to control peri-implant infections.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteria, Anaerobic; Clavulanic Acids; Dental Implants; Dental Plaque; Dental Plaque Index; Drug Combinations; Fusobacterium nucleatum; Humans; Metronidazole; Microbial Sensitivity Tests; Penicillin G; Periodontal Index; Periodontitis; Periodontium; Porphyromonas gingivalis; Prevotella intermedia; Prosthesis Failure; Prosthesis-Related Infections

Subgingival plaque samples from 20 patients with chronic periodontitis who had received no antibiotics for at least 3 months were screened for the presence of beta-lactamase-producing bacteria. Thirteen of the patients harboured beta-lactamase producing bacteria, most of which were members of the genus Bacteroides. The most frequently isolated species were Bacteroides melaninogenicus and Bacteroides capillosus which are often implicated in acute oral infections. All of the beta-lactamase-producing bacteroides strains were sensitive to a combination of amoxycillin with clavulanic acid (Augmentin).

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Bacillus; Bacteria; Bacteroides; beta-Lactamases; Chronic Disease; Clavulanic Acids; Dental Plaque; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Penicillin Resistance; Periodontitis; Prevotella melaninogenica; Pseudomonas aeruginosa