amoxicillin-potassium-clavulanate-combination and Periodontitis

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.. 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.. 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).. 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.

Topics: Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Child; Child, Preschool; Dental Caries; Dose-Response Relationship, Drug; Female; Gingivitis; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Male; Microbial Sensitivity Tests; Periodontitis; Pulpitis; Treatment Outcome

This study evaluates the efficacy of various antimicrobial treatments for orofacial infections on the basis of pharmacokinetic/pharmacodynamic (PK/PD) criteria.. A complete a literature search was undertaken to establish the MIC90 values of the five microorganisms most frequently isolated in odontogenic infections and the pharmacokinetic parameters of 13 antibiotics used in these infections. Pharmacokinetic simulations were then carried out with mean population parameters and efficacy indexes were calculated for the 47 treatment regimens analyzed. For drugs showing time-dependent antibacterial killing, the time above MIC (t > MIC) was calculated. For drugs with concentration-dependent bactericidal activity, the AUC/MIC was calculated.. Amoxicillin-clavulanic (500 mg/8 h or 1000 mg/12 h) and clindamycin (300 mg/6 h) in the time-dependent killing group and moxifloxacin (400 mg/24 h) in the concentration-dependent group showed adequate efficacy indexes against the five pathogens considered to be the most commonly implicated in odontogenic infections. The spiramycin plus metronidazole combination, present in the commercial formulation Rhodogyl, did not reach satisfactory PK/PD indexes.. PK/PD indexes, which are useful predictors of the potential efficacy of antibacterial therapy, were used with ontogenic infections in the present study. The PK/PD simulations showed that amoxicillin-clavulanic, clindamycin and moxifloxacin were the most suitable antibiotics for this kind of infection. Clinical trials are required to confirm that this methodology is useful in these pathologic processes.

Topics: Algorithms; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Area Under Curve; Aza Compounds; Bacterial Infections; Clindamycin; Clinical Trials as Topic; Dose-Response Relationship, Drug; Drug Therapy, Combination; Fluoroquinolones; Fusobacterium nucleatum; Humans; Microbial Sensitivity Tests; Mouth Diseases; Moxifloxacin; Peptostreptococcus; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Quinolines; Time Factors; Viridans Streptococci

Periodontal diseases are infections and thus systemically administered antibiotics are often employed as adjuncts for their control. There are conflicting reports as to whether these agents provide a therapeutic benefit.. The purpose of this systematic review is to determine whether systemically administered antibiotics improve a primary clinical outcome measure, periodontal attachment level change.. In patients with periodontitis, what is the effect of systemically administered antibiotics as compared to controls on clinical measures of attachment level?. The Pub/Med database was searched from 1966 to May 2002. Searches were limited to human studies published in English. Hand searches were performed on the Journal of Clinical Periodontology, Journal of Periodontology, and Journal of Periodontal Research. References in relevant papers and review articles were also examined.. Trials were selected if they met the following criteria: randomized controlled clinical trials, quasi-experimental studies, and cohort studies of > 1 month duration with a comparison group; subjects with aggressive, chronic, or recurrent periodontitis and periodontal abscess; use of a single or a combination of systemically administered antibiotics(s) versus non-antibiotic therapy; and a primary outcome of mean attachment level change (AL).. Studies involving the use of low-dose doxycycline, combinations of locally plus systemic antibiotics, or where the control group included a systemically administered antibiotic were excluded.. A mean difference in AL between groups was available for all papers used in the meta-analysis. A standard deviation (SD) for the difference was used if provided or calculated from the SD or standard error of the mean (SEM) when provided for single measurements. Data were subset by antibiotic employed, type of adjunctive therapy, and disease type. Results were assessed with both fixed-effects and random-effects models.. 1. Twenty-nine studies, 26 RCTs and 3 quasi-experimental (36 comparisons), met the entry criteria. Total study population, both control and test groups, was estimated at over 1,200. 2. Twenty-two studies (27 comparisons) were used in the meta-analysis, evaluating if the antibiotics provided a consistent benefit in mean AL change for different patient populations, for different therapies, and for different antibiotics. 3. For the majority of the comparisons, systemically administered antibiotics exhibited a more positive attachment level change than the control group in the study. The combined results were statistically significant (P < 0.001). 4. The systemic antibiotics were uniformly beneficial in providing an improvement in AL when used as adjuncts to scaling and root planing (SRP) and were consistently beneficial, although of borderline significance, when used as adjuncts to SRP plus surgery or as a stand alone therapy. 5. When examining the effects of individual or combinations of antibiotics, it was found that there were statistically significant improvements in AL for tetracycline, metronidazole, and an effect of borderline statistical significance for the combination of amoxicillin plus metronidazole. 6. Improvements in mean AL were consistent for both chronic and aggressive periodontitis subjects, although the aggressive periodontitis patients benefited more from the antibiotics.. 1. The use of systemically administered adjunctive antibiotics with and without SRP and/or surgery appeared to provide a greater clinical improvement in AL than therapies not employing these agents. 2. The data supported similar effect sizes for the majority of the antibiotics; therefore, the selection for an individual patient has to be made based on other factors. 3. Due to a lack of sufficient sample size for many of the antibiotics tested, it is difficult to provide guidance as to the more effective ones.

Topics: Administration, Oral; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Clindamycin; Consensus; Dental Scaling; Doxycycline; Humans; Metronidazole; Penicillins; Periodontal Attachment Loss; Periodontal Index; Periodontitis; Spiramycin; Tetracycline

Many antibiotics and other chemotherapeutic agents have been used as adjuncts to mechanical periodontal therapy with mixed results. This article reviews the clinical and microbial results obtained after the systemic administration of tetracyclines, penicillins, clindamycin, and metronidazole, as well as the combination of metronidazole and Augmentin as adjuncts to conventional periodontal treatment. The major adverse effects associated with each of these antibiotics are given, as well as the potential for the emergence of antibiotic resistance in the periodontal flora. Recently, the introduction of a new generation of controlled-release, locally applied antimicrobial agents provides the clinician with the opportunity to treat individual periodontal sites with high concentrations of medication. The clinical effects obtained from multicenter clinical trials with PerioChip, which contains chlorhexidine, and with Atridox, which contains doxycycline, are summarized. Finally, suggestions are given both for the selection of an antimicrobial agent and for minimizing the development of antibiotic resistance in the periodontal flora.

Topics: Administration, Oral; Administration, Topical; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chemotherapy, Adjuvant; Chlorhexidine; Clindamycin; Doxycycline; Drug Resistance, Microbial; Humans; Metronidazole; Periodontitis

The main aim of treatment for acute necrotizing periodontal disease is fast and effective reduction of anaerobic destructive microorganisms to avoid periodontal damage. The effect of adjunctive local oxygen therapy in the treatment of necrotizing periodontal disease was examined in this study.. Thirty patients with acute necrotizing periodontal disease were treated with the systemic antibiotics amoxicillin, clavulanic acid, and metronidazole. In 15 out of 30 patients, adjunctive local oxygen therapy was administered. The patients were followed from the first to 10th day of treatment with clinical and bacteriological examinations. The clinical examination registered gingival bleeding, periodontal probing depth, and attachment loss; to follow up microbiological colonization of the periodontal sulcus, five representative bacteria were registered by a semiquantitative DNA polymerase chain reaction test.. In both groups of patients, colonization with Prevotella intermedia, Tannerella forsythensis, and Treponema denticola was initially positive. None of these three microorganisms were completely eradicated in any of the patients in the group without oxygen therapy within the first 10 days of treatment. In the group with adjunctive oxygen therapy, all patients either showed a reduction in or complete eradication of the microorganisms, resulting in more rapid clinical restitution with less periodontal destruction.. Adjunctive oxygen therapy results in early eradication of pathogenic anaerobic microorganisms in cases of acute necrotizing periodontal disease. The damage to periodontal tissue is reduced.

Topics: Acute Disease; Administration, Topical; Adult; Aggregatibacter actinomycetemcomitans; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Bacteroides; Follow-Up Studies; Gingival Hemorrhage; Humans; Metronidazole; Middle Aged; Necrosis; Oxygen; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Smoking; Treponema denticola

The literature suggests that an alteration in glucose metabolism occurs as a result of antibacterial periodontal therapy. The objective of this study was to monitor the effect of non-surgical periodontal therapy on glycemic control in patients with type 2 diabetes mellitus (DM).. Thirty type 2 DM subjects with periodontitis were randomly divided into two groups. Group 1 (G1), 15 subjects, received one-stage full-mouth scaling and root planing (FMSRP) plus amoxicillin/clavulanic acid 875 mg; group 2 (G2), 15 patients, received only FMSRP. At baseline and after 3 months, the glycated hemoglobin (HbA1c) values, fasting glucose, and clinical parameters (with computerized probing and individualized acrylic stents) were recorded. Following therapy, the subjects were enrolled in a 2-week interval maintenance program for 3 months.. After treatment, both groups showed clinical improvements. A probing depth (PD) reduction of 0.8 +/- 0.6 mm (P < 0.05) occurred in G1 and 0.9 +/- 0.4 mm in G2 (P < 0.05), but there were no significant changes in attachment level. Treatment reduced the HbA1c values after the 3-month observation period in both groups; however, the reduction in HbA1c values for the G2 group was statistically significant, but not for the G1 group. The changes in fasting glucose levels were not significant for either group.. Periodontal therapy improved glycemic control in patients with type 2 DM in both groups; however, the reduction in HbA1c values reached statistical significance only in the group receiving scaling and root planing alone [correction].

Topics: Amoxicillin-Potassium Clavulanate Combination; Analysis of Variance; Blood Glucose; Dental Scaling; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Fasting; Follow-Up Studies; Glycated Hemoglobin; Humans; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Root Planing; Statistics, Nonparametric

This study was designed to evaluate the clinical significance of antibiotic therapy combined with guided tissue regeneration (GTR) therapy with a collagen membrane. The subjects were 20 adults diagnosed with periodontitis (20 intrabony periodontal defects). Ten patients were treated with GTR alone (control group) and the other 10 patients were treated with a combination of GTR and antibiotics (antibiotic group). In the antibiotic group, minocycline ointment was applied locally before GTR therapy, and doxycycline and amoxyline were systemically administered after GTR therapy. Clinical manifestations, the presence or absence of exposed membrane, and microbiological findings were assessed 1 month before, immediately after, and 2 weeks, 6 weeks, and 3 months after GTR therapy. The results showed no significant differences in reduction of probing depth, probing attachment gain (PAG), or the ratio of PAG to intraoperative depth of the intrabony defect (vertical relative attachment gain) between the antibiotic group and the control group before and 3 months after GTR therapy. A DNA probe test and specific enzymatic activity test revealed no significant differences in the improvement and the rate of bacterial negativity before, and 6 weeks and 3 months after, GTR therapy. These findings indicate that antibiotic therapy is not clinically beneficial when combined with GTR therapy with a collagen membrane.

Topics: Absorbable Implants; Adult; Aged; Aggregatibacter actinomycetemcomitans; Alveolar Bone Loss; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteroides; Collagen; DNA Probes; Doxycycline; Drug Therapy, Combination; Female; Follow-Up Studies; Guided Tissue Regeneration, Periodontal; Humans; Male; Membranes, Artificial; Middle Aged; Minocycline; Ointments; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Statistics as Topic; Treponema

Although the use of systemic antibiotics has been studied in patients with generalized aggressive periodontitis (formerly rapidly progressive periodontitis), the use of adjunctive tetracycline fibers in these patients has not been reported. The purpose of the present study was to compare the clinical response of local versus systemic antibiotic treatment as adjuncts to scaling and root planing in patients with GAgP.. After initial therapy and full-mouth scaling and root planing (SRP), 30 patients were randomly assigned to 1 of 2 antibiotic treatment groups. Probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded with an automated probe prior to SRP at baseline (BL) and 15, 30, 41, and 54 weeks later. Three months after SRP, the patients were treated with amoxicillin/clavulanic acid (500 mg tid; SRP + AUG group) or with local tetracycline fiber in pockets with PD > or =5 mm (SRP + TCF group).. In both treatment groups, PD decreased significantly from BL to week 54 (6.2+/-1.5 mm to 4.7+/-1.4 mm for SRP + TCF and 6.5+/-1.4 mm to 4.2+/-0.6 mm for SRP + AUG). However, there was no statistically significant difference between the 2 groups in pocket reduction. Similarly, in both treatment groups, there were small but significant gains in CAL from BL to week 54 (12.0+/-1.8 mm to 11.3+/-1.8 mm for SRP + TCF and 12.3+/-1.5 mm to 11.2+/-1.2 mm for SRP + AUG). The difference in CAL gain between the 2 groups was not statistically significant. At the final examination, both groups showed significant PD reduction and CAL gain (P <0.001) compared to BL. The frequency and percentage of bleeding sites decreased significantly in both groups. At week 54, this decrease was significantly greater in the SRP + AUG group (31.67% for SRP + TCF versus 3.85% for SRP + AUG).. These results indicate that the local delivery of tetracycline by a fiber or the systemic administration of amoxicillin/clavulanic acid given 3 months after scaling and root planing produced similar clinical outcomes over the 9-month observation period.

Topics: Administration, Oral; Administration, Topical; Adult; Aggressive Periodontitis; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Dental Scaling; Drug Therapy, Combination; Humans; Periodontal Index; Periodontitis; Statistics, Nonparametric; Tetracycline

Between 4 and 8% of periodontitis patients are reported to respond poorly to conventional therapy. In these cases, adjunctive use of systemic antibiotics might be a reasonable therapeutic approach. The purpose of this study was to evaluate the effects of systemic amoxicillin/clavulanate as adjunct to periodontal surgery on the predominant subgingival microorganisms in patients not responding to mechanical therapy. Furthermore, the bacterial susceptibility to amoxicillin/clavulanate was analyzed before and after therapy in order to assess the clinical validity of pre-therapeutic susceptibility testing.. In 10 periodontitis subjects with no subgingival detection of Actinobacillus actinomycetemcomitans, the predominant subgingival organisms were identified using the identification system Rapid ID 32 A as well as antibiotic susceptibility was tested utilizing the E test.. Porphyromonas gingivalis and Prevotella oralis were detected in 7/10 subjects and could no more recovered after therapy. Fusobacterium nucleatum and Peptostreptococcus micros were present in 5/10 patients before treatment, but could be detected in 6/10, resp. 3/10 after therapy. In 4/10 subjects harboring F. nucleatum and in 3/10 with P. micros, those organisms were not targeted by amoxicillin/clavulanate, although post-treatment testing revealed their alleged susceptibility (MICs varied from 0.023 to 0.032 microg/ml, resp. from 0.125 to 2.0 microg/ ml).. The results of this study suggest that the outcomes of conventional methods of susceptibility testing have to be interpreted very carefully when being used for treatment of plaque-related diseases. Furthermore, since the endpoint of systemic antibiotic treatment as adjunct to conventional therapy is elimination of F. nucleatum or P. micros in patients harboring these organisms, the use of amoxicillin/clavulanate appears not to be justified.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Bacteria, Anaerobic; Drug Therapy, Combination; Female; Fusobacterium; Humans; Male; Microbial Sensitivity Tests; Peptostreptococcus; Periodontitis; Porphyromonas gingivalis; Prevotella

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 systemic use of a single antibiotic was compared to that of a sequential antibiotic regimen in the treatment of A. actinomycetemcomitans and/or P. gingivalis-associated periodontitis. Eleven patients with recurrent/progressive periodontitis and demonstrating subgingival infection with A.a. and/or P.g. were selected. Six patients received oral administration of doxycycline (Do), 200 mg the first day and 100 mg for 4 days thereafter, and then amoxicillin/clavulanate potassium (Au), 500 mg 3 times daily for 5 days. The other 5 patients received only doxycycline for 10 days. Eight sites with > or = 5 mm probe depth per patient were selected, of which 4 received root planing at time 0. Clinical measurements (GI and PI, probing pocket depth, probing attachment level, and bleeding upon probing/suppuration) and microbial infection levels (2 sites/patient as per DNA probe) for A.a. and P.g. were recorded at 0, 4, 12, and 25 weeks. Clinical data were subjected to statistical analysis of variance and t-tests for significance. The Do + Au groups produced significant reduction in probing pocket depth (PPD) at 4, 12, and 25 weeks (1.1, 1.3, and 1.1 mm, respectively). The Do group produced significant reduction in PPD only at 4 and 12 weeks (0.8 and 0.8 mm); the Do + Au group produced significant gain of 0.8 mm in probing attachment level at 4 and 12 weeks; and the Do + Au group in conjunction with root planing produced the most sustained reduction in PPD and gain in PAL. These findings suggest that the sequential use of multiple antibiotic agents may offer greater promise as an adjunctive treatment approach for the management of recurrent and/or progressive periodontitis than a single antibiotic regimen.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aggregatibacter actinomycetemcomitans; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Child; Clavulanic Acids; Colony Count, Microbial; Dental Plaque Index; Doxycycline; Drug Therapy, Combination; Gingival Hemorrhage; Humans; Middle Aged; Periodontal Index; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Recurrence; Root Planing

The dysbiosis of bacteria and horizontal transfer of antibiotic resistance genes (ARGs) could be highly problematic particularly in the oral environment. Here, we aimed to identify the anaerobic species from patients with periodontitis and to screen the isolates for the β-lactamase resistance genes, bla. The species with frequency higher than 10% were Lactobacillus spp. (26.3%), Streptococcus spp. (18.8%), Leptotrichia wadei (14%) and Veillonella spp. (11.4%). The bla. This study showed that various anaerobes species may be involved in the development of periodontitis. Of them, Prevotella and Veillonella species were found to commonly carry cfxA even though they are susceptible to beta-lactams and its combination.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteria, Anaerobic; beta-Lactam Resistance; beta-Lactamases; Humans; Iran; Microbial Sensitivity Tests; Periodontitis; RNA, Ribosomal, 16S

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Humans; Metronidazole; Periodontitis

Association between chronic lung disease and peri-odontal infection has recently been reported. The microbiology of peri-odontal infection and lung infection is almost similar. The most direct means by which the oral infection might influence lung disease is by aspiration of dental plaque bacteria into the lower respiratory tract. In this case report we are presenting a patient who suffered recurrent lung infection. Intra-oral examination revealed the presence of chronic peri-odontitis, which was not treated before. On providing treatment for lung infection in addition to that for peri-odontal infection, there was no recurrence of lung infection.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Diagnosis, Differential; Fusobacterium Infections; Fusobacterium nucleatum; Humans; Male; Metronidazole; Middle Aged; Periodontitis; Pneumonia; Recurrence

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

Although polymicrobial infections, such as peri-implantitis or periodontitis, were postulated in the literature to be caused by synergistic effects of bacteria, these effects remain unclear looking at antibiotic susceptibility. The aim of this study is to compare the antibiotic susceptibilities of pure cultures and definite cocultures.. Laboratory strains of Aggregatibacter actinomycetemcomitans (Aa) (previously Actinobacillus actinomycetemcomitans), Capnocytophaga ochracea (Co), and Parvimonas micra (Pm) (previously Peptostreptococcus micros) were cultivated under anaerobic conditions, and their susceptibilities to 10 antibiotics (benzylpenicillin G, ampicillin, amoxicillin, ampicillin/sulbactam, amoxicillin/clavulanic acid, minocycline, metronidazole, linezolid, azithromycin, and moxifloxacin) were tested using the Epsilometertest. Cocultures, each consisting of two or three bacteria, were treated analogously.. All four cocultures showed lower susceptibilities to azithromycin and minocycline than to pure cultures. The coculture Aa-Co showed a lower susceptibility to moxifloxacin as did the coculture Aa-Pm to benzylpenicillin G; the coculture Co-Pm showed a lower susceptibility to amoxicillin, amoxicillin/clavulanic acid, metronidazole, and benzylpenicillin G. However, the coculture Co-Pm showed a higher susceptibility to ampicillin, linezolid and moxifloxacin as did Aa-Pm and Aa-Co-Pm to linezolid.. In addition to established in vitro assays, it was demonstrated that antimicrobial cocultures caused antibiotic susceptibilities that differed from those of pure cultures. Bacterial cocultures frequently showed lowered susceptibilities to antibiotics.

Topics: Acetamides; Actinobacillus Infections; Aggregatibacter actinomycetemcomitans; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Aza Compounds; Azithromycin; Capnocytophaga; Coculture Techniques; Coinfection; Drug Resistance, Bacterial; Fluoroquinolones; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Linezolid; Metronidazole; Microbial Interactions; Minocycline; Moxifloxacin; Oxazolidinones; Penicillin G; Peptostreptococcus; Peri-Implantitis; Periodontitis; Quinolines; Sulbactam

Chédiak-Higashi syndrome (CHS) is a rare immunodeficient disorder. Patients with CHS are prone to severe periodontitis. To date, limited improvement following periodontal therapy has been reported. Thus, successful clinical outcomes in patients with CHS are of interest.. A 12-year-old girl was referred to the Department of Pediatric Dentistry, Hôtel-Dieu/Garancière Hospital, for acute gingival inflammation and periodontal destruction. After a periodontal examination, the patient was sent to the Department of Medicine, Robert Debré Hospital, for a hematologic examination and was diagnosed with CHS. She has been receiving medical and dental treatments since that time. The medical treatment consisted of continuous, long-term antibiotherapy. Supportive periodontal therapy was initiated with 4-month recall periods. We report the diagnosis process and the 9-year follow-up.. Radiographs and a periodontal examination showed deep probing pockets and extensive alveolar bone resorption. Hematologic and immunologic investigations showed normal values. Peripheral blood smears showed giant granules in neutrophils and leukocytes characteristic of CHS. Clinical improvement was observed after the initial periodontal therapy. No periodontitis recurrence was noted over a period of 9 years.. This case report shows that it is possible to treat periodontitis and maintain the periodontal health of a patient with a mild CHS phenotype over a long period. Patient compliance, regular dental follow-ups, and long-term systemic antibiotic treatments may be useful in stabilizing the periodontal condition of patients with CHS. Dentists must be aware that aggressive periodontitis, combined with general clinical signs, in young patients may reflect rare systemic disorders requiring biologic investigation.

Topics: Alveolar Bone Loss; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chediak-Higashi Syndrome; Child; Chlorhexidine; Dental Care for Chronically Ill; Dental Scaling; Female; Follow-Up Studies; Gingivitis; Humans; Periodontal Pocket; Periodontitis; Root Planing

Obligate anaerobes are closely involved in the pathogenesis of oral and focal infections. The objective of this study was to evaluate the susceptibility profiles of obligate anaerobes of oral origin to telithromycin (TLM), moxifloxacin (MXF), and other antibiotics that are commonly used in dentistry.. The study sample comprised 172 obligate anaerobes isolated from the saliva of 43 adult volunteers. The minimum inhibitory concentrations (MICs) were determined by the agar dilution technique in Brucella agar medium supplemented with vitamin K, haemin and 5% (volume/volume) laked sheep blood, and incubated under anaerobic conditions. The Clinical and Laboratory Standards Institute methodology was followed and its criteria were used for the qualitative interpretation of the results. The antibiotics evaluated were: amoxicillin (AMX), amoxicillin-clavulanic acid (AMX-CLA), clindamycin (CM), metronidazole (MTZ), azithromycin (AZM), TLM and MXF.. Resistance to AMX (MIC(90) > or = 16 mg/l) was observed in 45.3% of the obligate anaerobes and resistance to CM (MIC(90) > or = 16 mg/l) was found in 18.6%. All the isolates were sensitive to MTZ (MIC(90) = 1 mg/l) and 98.8% were sensitive to AMX-CLA (MIC(90) = 2 mg/l). The MIC(90) values for AZM, TLM and MXF were > or =16, > or =8 and > or =2 mg/l, respectively.. Pathogenic, opportunistic and non-pathogenic obligate anaerobes showed high percentages of resistance to AMX and CM, and high MIC values for AZM in the absence of recently administered antibiotics. MXF showed a higher activity than TLM, similar to that detected for AMX-CLA and MTZ. In consequence, MXF could represent a possible alternative antimicrobial against obligate anaerobes of oral origin, particularly in those patients with allergy, intolerance or lack of response to AMX-CLA or MTZ.

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Aza Compounds; Azithromycin; Blood; Clindamycin; Culture Media; Drug Resistance, Bacterial; Fluoroquinolones; Gram-Negative Anaerobic Bacteria; Hemin; Humans; Ketolides; Metronidazole; Microbial Sensitivity Tests; Moxifloxacin; Penicillin Resistance; Periodontitis; Quinolines; Saliva; Vitamin K

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

This prospective study was designed to investigate amoxicillin-resistant oral anaerobes, and to identify their beta-lactamase-encoding genes. Three subgingival bacterial samples were collected from 12 patients suffering from periodontitis. One to seven beta-lactamase-producing strains were obtained from each patient, mostly belonging to the Prevotella genus (Bacteroides eggerthii, 2/35 strains; Prevotella sp., 33/35 strains). PCR assays were used to detect cfxA and cepA/cblA, the genes encoding class A/group2e beta-lactamases previously described in the Bacteroides fragilis group. The present investigation confirmed the role of Prevotella species as beta-lactamase producers in periodontal pockets. Additionally, this PCR screening showed (1): the high prevalence of CfxA beta-lactamase production by aminopenicillin-resistant Prevotella (32/33: 97.0% positive strains) vs. cepA/cblA (1/33: 3.0% positive strains), and (2) the presence of cfxA in the periodontal reservoir in the absence of antimicrobial therapy during the previous 6 months.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactamases; Drug Resistance, Bacterial; Drug Therapy, Combination; Erythromycin; Fimbriae Proteins; Genes, Bacterial; Humans; Membrane Proteins; Penicillin Resistance; Penicillins; Periodontal Pocket; Periodontitis; Phenotype; Polymerase Chain Reaction; Prevotella; Prospective Studies; Tetracycline; Tetracycline Resistance

The occurrence and in vitro antimicrobial sensitivity of isolates of enteric rods and pseudomonads were examined in 80 periodontitis patients, 17 to 58 years of age, in São Paulo, Brazil. Speciation and in vitro antimicrobial susceptibility testing were performed using the BBL Crystal enteric/nonfermenter system and the Etest for amoxicillin/clavulanic acid, ciprofloxacin and doxycycline. A total of 30 strains were isolated from 25 (31.2%) of the study subjects. Pseudomonas aeruginosa occurred in nine patients, Serratia marcescens in seven, and five other species were recovered in lower prevalence. All study organisms demonstrated high susceptibility to ciprofloxacin but exhibited variable susceptibility patterns to the other antimicrobial agents tested. In conclusion, the high occurrence of enteric rods and pseudomonads in these subjects may be important in the pathogenesis of periodontitis, and ciprofloxacin might be the antibiotic of choice to eradicate these pathogens from periodontal pockets.

Topics: Adolescent; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Brazil; Ciprofloxacin; Doxycycline; Drug Therapy, Combination; Enterobacteriaceae; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Periodontal Pocket; Periodontitis; Pseudomonas

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

Leukocyte adhesion deficiency is a rare inherited defect of phagocytic function resulting from a lack of leukocyte cell surface expression of beta2 integrin molecules (CD11 and CD18) that are essential for leukocyte adhesion to endothelial cells and chemotaxis. A small number of patients with leukocyte adhesion deficiency-1 have a milder defect, with residual expression of CD18. These patients tend to survive beyond infancy; they manifest progressive severe periodontitis, alveolar bone loss, periodontal pocket formation, and partial or total premature loss of the primary and permanent dentitions. We report on a 13-year-old boy with moderate leukocyte adhesion deficiency-1 and severe prepubertal periodontitis. This case illustrates the need for the dentist to work closely with the pediatrician in the prevention of premature tooth loss and control of oral infection in these patients.

Topics: Adolescent; Alveolar Bone Loss; Amoxicillin-Potassium Clavulanate Combination; Dental Care for Chronically Ill; Gingival Hyperplasia; Humans; Leukocyte-Adhesion Deficiency Syndrome; Male; Oral Ulcer; Periodontitis; Radiography; Tooth Loss

Antibiotic resistance has been increasingly described among bacterial species colonizing periodontal pockets, particularly in Prevotella and Porphyromonas spp. strains producing beta-lactamases, and frequently associated with resistance to tetracycline and erythromycin. These resistance genes may be carried on motile genetic elements, or transposons, capable of interspecies and intergeneric transmission among bacterial strains colonizing a same ecological niche. The aim of this prospective study was to determine the resistance profile of Actinobacillus actinomycetemcomitans and the prevalence of A. actinomycetemcomitans strains producing beta-lactamases in periodontal pockets.. Fifty strains of A. actinomycetemcomitans were isolated from 42 patients with adult periodontitis. No patient had periodontal or antibiotic therapy in the previous 6 months. Bacterial samples were collected from periodontal pockets > or =5 mm, appropriately diluted, inoculated onto selective medium (chocolate blood agar with bacitracin 75 microg/ml and vancomycin 5 microm/ml) and incubated for 5 days at 37 degrees C in air with 5% CO2. After conventional identification, susceptibility testing to 11 antibiotics was performed by the broth dilution method, in trypticase soy broth supplemented with yeast extract, hemin, and 0.1% NaHCO3 to maintain microaerophilic conditions in the microtitration plate wells by CO2 formation.. No strain demonstrated resistance to amoxicillin, amoxicillin-clavulanic acid combination, pristinamycin, or ciprofloxacin at the breakpoint, but 40% of the strains were slightly resistant to penicillin G, and 4% were resistant to erythromycin, 90% to spiramycin, 18% to clarythromycin, 4% to tetracycline, 72% to metronidazole, and 12% to ornidazole. Amoxicillin, followed by tetracycline and erythromycin, was the most effective antibiotic on A. actinomycetemcomitans. The phenotypic research of a beta-lactamase was negative for all the strains tested.. In this work, most A. actinomycetemcomitans strains were resistant to metronidazole, but the amoxicillin-metronidazole association may be of interest against subgingival anaerobic and capnophilic mixed flora. Pristinamycin and ciprofloxacin appeared as effective alternative monotherapies against A. actinomycetemcomitans. The threat of beta-lactam antibiotic resistance related to beta-lactamase production is currently not a problem with A. actinomycetemcomitans as it has been reported in oral anaerobes.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactamases; Ciprofloxacin; Drug Resistance, Microbial; Erythromycin; Humans; Metronidazole; Microbial Sensitivity Tests; Ornidazole; Periodontal Pocket; Periodontitis; Species Specificity; Spiramycin; Tetracycline; Virginiamycin

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 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.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactamase Inhibitors; Chromatography, High Pressure Liquid; Drug Therapy, Combination; Enzyme Inhibitors; Female; Follow-Up Studies; Gingival Crevicular Fluid; Gram-Negative Anaerobic Bacteria; Humans; Male; Periodontal Pocket; Periodontitis; Prevotella; Prevotella intermedia

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Dental Scaling; Drug Therapy, Combination; Humans; Male; Metronidazole; Periodontal Abscess; Periodontal Index; Periodontitis; Root Planing

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

Guided tissue regeneration procedures with Gore-Tex Periodontal Material are associated with a unique set of postoperative healing characteristics. Five healing complications are described in this study examining 102 sites. The occurrence of pain and purulence were the most common. In purulent sites, the majority of bacteria cultured were Actinomyces and Streptococcus spp. Resistance to antibiotics was common. Prevention and treatment of the healing complications are discussed.

Topics: Actinomyces; Adolescent; Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Chi-Square Distribution; Clavulanic Acids; Doxycycline; Drug Resistance, Microbial; Drug Therapy, Combination; Edema; Female; Furcation Defects; Gingival Diseases; Guided Tissue Regeneration, Periodontal; Humans; Male; Membranes, Artificial; Microbial Sensitivity Tests; Middle Aged; Pain, Postoperative; Periodontitis; Polytetrafluoroethylene; Postoperative Complications; Prevotella intermedia; Streptococcus; Suppuration; Surgical Flaps; Wound Healing

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