Metronidazole plus amoxycillin in the treatment of <i>Actinobacillus</i> associated periodontitis

Winkelhoff, A.J. van; Rodenburg, Jessica; Goené, R.J.; Abbas, Frank; Winkel, Edwin; Graaff, J. de

doi:10.1111/j.1600-051x.1989.tb01626.x

Cited by 297 publications

(221 citation statements)

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“…However, the results of the pilot are comparable to those of metronidazole in the same human study on the effects of metronidazole plus cefixime and fluids (10), which indicates that the hydroxymetabolite probmetronidazole plus ciprofloxacin indicate that in vitro synably contributes significantly to the effectiveness of the ergy between metronidazole, its hydroxymetabolite, and metronidazole-amoxicillin combination. The nature of the cefixime and ciprofloxacin may have a predictive value for The results of previous studies (5,11,15,18,26,31,32,34,35) and the results of our pilot study suggest that eradication ofA. actinomycetemcomitans is predictable when combinations of antibiotics show in vitro synergism.…”

Section: Methodsmentioning

confidence: 52%

“…For adequate treatment of this infection, antibiotics are required. In 1989, van Winkelhoff et al (34) showed that mechanical treatment followed by a regimen of metronidazole and amoxicillin for 7 days is effective in eliminating A. actinomycetemcomitans from the infected sites. Recently, this was confirmed in a large patient group, in which more than 95% eradication of the microorganism was reported (35).…”

mentioning

confidence: 99%

“…actinomycetemcomitans-associated periodontitis by subgingival debridement has appeared ineffective with regard to eradication ofA. actinomycetemcomitans from the periodontal area (23,24,31 (34) showed that mechanical treatment followed by a regimen of metronidazole and amoxicillin for 7 days is effective in eliminating A. actinomycetemcomitans from the infected sites. Recently, this was confirmed in a large patient group, in which more than 95% eradication of the microorganism was reported (35).…”

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confidence: 99%

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In vitro susceptibilities of Actinobacillus actinomycetemcomitans to a number of antimicrobial combinations

Pavičić

Winkelhoff

Graaff

1992

Antimicrob Agents Chemother

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The in vitro susceptibilities of Actinobacilus actinomycetemcomitans to 14 antimicrobial combinations were studied by using the checkerboard titration technique. The results, expressed as the range of the fractional inhibitory concentration indices, were as follows: for metronidazole or its hydroxymetabolite combined with cefixime, 0.2 to 0.6; for moxalactam, 0.2 to 0.6; for penicillin G, 0.3 to 0.6; for tobramycin, 0.8 to 2.0; for erythromycin, 0.8 to 1.7; for ciprofloxacin, 0.2 to 0.6; for tetracycline, 0.8 to 1.2. Our observations indicated that the 1-lactam antibiotics as well as ciprofloxacin act synergistically with both metronidazole and its hydroxymetabolite againstA. acinomycetemcomians. Synergistic interactions were independent ofthe individual MICs of the antibiotics tested. Erythromycin, tobramycin, and tetracycline combined with either metronidazole or its hydroxymetabolite showed additive to indifferent effects against the five strains ofA. actdnmycetemcomians, with the fractional inhibitory concentration indices ranging from 0.8 to 2.0. A. actinomycetemomitan was found to be hily susceptible to ciprofloxacin (MIC of ciprofloxacin for 90%o of strains tested, 0.010 p.g/ml) and cefixime (MIC of cefxime for 901% of strains tested, 0.8 ,ug/ml). The results indicate that in patients who are allergic to penicillin, cefixime and ciprofloxacin may be useful alternative antibiotics in combination with metronidazole for the treatment ofA. acdnomycetemcomians-associated periodontitis.Actinobacillus actinomycetemcomitans, a rod-shaped gram-negative coccobacillus, is a pathogen in several nonoral diseases (9,13,14,21,36) and a putative pathogen in periodontal disease (4,7,15,25,29,30,36). Treatment ofA. actinomycetemcomitans-associated periodontitis by subgingival debridement has appeared ineffective with regard to eradication ofA. actinomycetemcomitans from the periodontal area (23,24,31 (34) showed that mechanical treatment followed by a regimen of metronidazole and amoxicillin for 7 days is effective in eliminating A. actinomycetemcomitans from the infected sites. Recently, this was confirmed in a large patient group, in which more than 95% eradication of the microorganism was reported (35). An explanation for the in vivo efficacy may be the in vitro synergism against A. actinomycetemcomitans not only between metronidazole and amoxicillin but also between metronidazole and its hydroxymetabolite as well as between amoxicillin and the hydroxymetabolite of metronidazole (20). However, in some patients, effective treatment with the metronidazole-amoxicillin combination is contraindicated for several reasons; patients can suffer from serious adverse effects caused by amoxicillin, and patients can have allergies toward 3-lactam antibiotics. An alternative antibiotic therapy for these patients is still not available.The aim of the study described here was to investigate the interactions between several antibiotic combinations by using the checkerboard titration technique (3) low-up to this study, the in vitro susc...

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Section: Methodsmentioning

confidence: 52%

mentioning

confidence: 99%

mentioning

confidence: 99%

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In vitro susceptibilities of Actinobacillus actinomycetemcomitans to a number of antimicrobial combinations

Pavičić

Winkelhoff

Graaff

1992

Antimicrob Agents Chemother

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“…Selective media were developed that allowed it to be detected even when it was greatly outnumbered by other plaque species (Slots, 1982;Mandell et al, 1987). As a result, it was implicated, on the basis of association-type studies, as a putative periodontal pathogen in refractory periodontitis, early-onset periodontitis, and in the rapidly deteriorating lesion (Tanner et al, 1979;Dzink et al, 1988;van Winkelhoff et al, 1989;Slots et al, 1990a;Haffajee and Socransky, 1994). Its persistence in plaque and presence within the gingival tissue were used to design antimicrobial regimens to eradicate it from both the plaque and the gingiva (Slots and Rosling, 1983;Mandell and Socransky, 1988;Goene et al, 1990;Christersson and Zambon, 1993;van Winkelhoff et al, 1992;Goodson, 1994).…”

Section: (A) the Non-specific Plaque Hypothesismentioning

confidence: 99%

The Antimicrobial Treatment of Periodontal Disease: Changing the Treatment Paradigm

Loesche

1999

Critical Reviews in Oral Biology & Medicine

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Over the last 100 years, methods of surgical periodontal treatment have enjoyed a history of success in improving oral health. The paradigm of care is based on the "non-specific plaque hypothesis"-that is, the overgrowth of bacterial plaques cause periodontal disease, and the suppression of this overgrowth reduces disease risk. The central feature of this approach to care is the removal of inflamed gingival tissue around the teeth to reduce periodontal pocket depth, thereby facilitating plaque removal by the dentist and by the patient at home. Over the last 30 years, with the recognition that periodontal disease(s) is caused by specific bacteria and that specific antimicrobial agents can reduce or eliminate the infection, a second paradigm has developed. This new paradigm, the "specific plaque hypothesis", focuses on reducing the specific bacteria that cause periodontal attachment loss. The contrast between the two paradigms can be succinctly stated as follows: The antimicrobial therapy reduces the cause, while the surgical therapy reduces the result of the periodontal infection. The specific plaque hypothesis has two important implications. First, with the increasing attention to evidence-based models for prevention, treatment, outcome assessment, and reimbursement of care, increasing attention and financial effort will be channeled into effective preventive and treatment methods. Second, the recent observations that periodontal infections increase the risk of specific systemic health problems, such as cardiovascular disease, argue for the prevention and elimination of these periodontal infections. This review highlights some of the evidence for the specific plaque hypothesis, and the questions that should be addressed if antimicrobial agents are to be used responsively and effectively.

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“…Infecties die worden veroorzaakt door exogene pathogenen worden meestal met antibiotica behandeld. Deze weg is ook gevolgd bij de behandeling van ernstige parodontale infecties waarbij deze bacteriën zijn betrokken ( Van Winkelhoff et al, 1989;Winkel et al, 2001). …”

Section: Porphyromonas Gingivalisunclassified

Proefschriften 25 jaar na dato 31

Winkelhoff¹

2012

NTvT

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InleidingBij parodontale infecties spelen micro-organismen een belangrijke rol. Voor gingivitis is dit onomstotelijk vastgesteld in het experimentele gingivitismodel (Löe et al, 1965). In de afgelopen decennia is duidelijk geworden dat plaquebacteriën een noodzakelijke voorwaarde zijn voor parodontitis maar waarschijnlijk niet een voldoende voorwaarde. Er zijn meerdere risicofactoren geïdentificeerd voor het ontstaan en de verergering van parodontitis, zoals specifieke paropathogene bacteriën, roken en diabetes mellitus. Er zijn sterke aanwijzingen dat ook andere factoren van belang zijn, zoals genetische aanleg, chronische stress, en een lage sociaaleconomische status.Er zijn ook aanwijzingen dat niet alle bacteriën in de subgingivale biofilm even pathogeen zijn en daarmee even belangrijk in het ziekteproces. Belangrijke parodontale pathogenen zijn onder andere vertegenwoordigers van de groep van zwartgepigmenteerde anaerobe bacteriën zoals Porphyromonas gingivalis en Prevotella intermedia. Vooral de eerste soort is sinds tientallen jaren onderwerp van wetenschappelijk onderzoek, niet in de laatste plaats omdat de eigenschappen van deze bacterie blijven verrassen. Zwartgepigmenteerde bacteriënDe geschiedenis van het onderzoek in de parodontale microbiologie begon met de publicatie van W.D. Miller over de microbiologie van Pyorrhoea alveolaris in 1890. Sindsdien ging de aandacht afwisselend uit naar de rol van stafylokokken, streptokokken, spirocheten, fusiforme bacteriën, amoeben en andere parasieten, afhankelijk van de techniek die werd gebruikt om de subgingivale plaque te bestuderen.Pas in de jaren '50 van de vorige eeuw, nadat de techniek van de strikt anaerobe kweekmethode op gang was gekomen, isoleerde men voor het eerst bacteriën die donker-en zwartgekleurde koloniën produceerden op bloedhoudende agarplaten. Nadat onderzoekers tevergeefs hadden gezocht naar specifieke pathogenen voor parodontitis ontstond een nieuw inzicht, dat het principe van de anaerobe menginfectie werd genoemd. Onderzoekers veronderstelden dat parodontitis wordt veroorzaakt door een combinatie van bacteriën die samen een pathogeen consortium vormen.Zeer belangrijk was de waarneming dat de zwartgepigmenteerde bacteriën, en in het bijzonder Bacteroides gingivalis, een essentiële rol speelden bij experimentele menginfecties. Combinaties van parodontale bacteriën waren zonder deze bacterie weinig virulent in proefdieren. Wanneer Bacteroides gingivalis werd toegevoegd werden de bacteriemengsels vaak letaal. ClassificatieDe classificatie en taxonomie van zwartgepigmenteerde mondbacteriën stond in de jaren '80 van de vorige eeuw nog in de kinderschoenen. Daar lag dus een belangrijk onderwerp voor microbiologisch onderzoek dat uiteindelijk leidde tot het proefschrift 'Black-pigmented Bacteriodes in human oral diseases ' (Van Winkelhoff, 1986). Dit onder-

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Metronidazole plus amoxycillin in the treatment of Actinobacillus associated periodontitis

Cited by 297 publications

References 20 publications

In vitro susceptibilities of Actinobacillus actinomycetemcomitans to a number of antimicrobial combinations

In vitro susceptibilities of Actinobacillus actinomycetemcomitans to a number of antimicrobial combinations

The Antimicrobial Treatment of Periodontal Disease: Changing the Treatment Paradigm

Proefschriften 25 jaar na dato 31

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