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Zahnmedizin up2date 2022; 16(03): 269-284
DOI: 10.1055/a-1842-3641
Parodontologie

Antibiotika in der parodontalen Therapie

Karin Jepsen
,
Raluca Cosgarea
,
Pia-Merete Jervøe-Storm
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Aufgrund der Rolle von Bakterien in der Ätiopathogenese der Parodontitis kommen Antibiotika in der Parodontologie bereits seit mehreren Jahrzehnten zum Einsatz. Eine sorgfältige Nutzen-Risiko-Abwägung hinsichtlich möglicher Nebenwirkungen und insbesondere Resistenzbildungen spielt heute eine sehr wichtige Rolle bei der Indikationsstellung. Dieser Beitrag fasst den aktuellen Stand vor dem Hintergrund neuer Erkenntnisse und Empfehlungen zusammen.
Kernaussagen

  • Systemische Antibiotika sollen bei Parodontitispatienten nicht routinemäßig zusätzlich zur subgingivalen Instrumentierung eingesetzt werden.

  • In einer Nutzen-Risiken-Analyse überwiegen Bedenken hinsichtlich unerwünschter Nebenwirkungen für den Patienten und Förderung der Antibiotikaresistenzen in der Bevölkerung.

  • Die adjuvante Verwendung bestimmter Antibiotika (Metronidazol mit oder ohne Amoxicillin) in der Therapiestufe 2 kann für bestimmte Patientengruppen mit nachgewiesener rascher Progression (z. B. generalisierte Stadien III/IV der Parodontitis bei jungen Erwachsenen) erwogen werden.

  • Die Behandlung dieser speziellen Hochrisikopatienten sollte idealerweise von Spezialist*innen durchgeführt werden (DG PARO-Spezialist oder Fachzahnarzt für Parodontologie).

  • Die Indikation und die Beurteilung des Behandlungserfolgs orientieren sich am klinischen Bild und nicht am Ergebnis mikrobiologischer Diagnostik.

  • Eine systemische Antibiotikagabe bei Parodontitispatienten darf keineswegs Ersatz für eine unzureichende subgingivale Instrumentierung oder mangelhafte Mundhygiene sein.

  • Der Nutzen einer perioperativen Antibiotikaprophylaxe bei parodontalchirurgischen Eingriffen oder aber derjenige einer systemischen antibiotischen Begleittherapie bei regenerativ-chirurgischen Eingriffen ist nicht erwiesen.

  • Bestimmte lokal applizierte Antibiotika mit anhaltender Freisetzung können bei Parodontitispatienten zusätzlich zur subgingivalen Instrumentierung erwogen werden.

  • Ihr Einsatz ist nur bei Patienten mit wenigen lokalisierten tiefen Taschen und bei sehr guter Mundhygiene sinnvoll, da andernfalls eine rasche Reinfektion stattfindet.

  • Akute parodontale Zustände (Taschenabszesse mit Ausbreitungstendenz beziehungsweise ulzerierende Parodontalerkrankungen) können eine systemische Antibiotikagabe erforderlich machen.

Schlüsselwörter

Schwere Parodontitis - adjuvante Antibiotika - aktuelle Behandlungsleitlinien


Publication History

Article published online:
22 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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