Möglichkeiten adjuvanter systemischer Antibiotikatherapie bei Parodontitis

Die Parodontitis ist eine Infektionserkrankung im Sinne einer opportunistischen Infektion. Je nach Form und Ausprägung sind verschiedene parodontopathogene Bakterien in einem Biofilm organisiert und an der Infektion beteiligt. Durch eine alleinige mechanische Parodontaltherapie können nicht alle parodontopathogenen Bakterien eliminiert werden. Dies kann zu klinischen Misserfolgen und Rezidiven führen.

In einigen Fällen ist es daher notwendig, die Therapie durch eine systemische Antibiotikagabe zu unterstützen. Ein routinemäßiger Einsatz adjuvanter systemischer Antibiotika ist jedoch abzulehnen. Bei plaqueassoziierten Gingivitiden und den meisten chronischen Parodontitiden hat eine unterstützende Antibiotikagabe keinen nachweislichen Nutzen. Eine Indikation für den zusätzlichen Einsatz von Antibiotika in der Parodontaltherapie ist lediglich bei einer aggressiven und/oder einer schweren chronischen Parodontitis, bei therapieresistenten oder refraktären Parodontitiden sowie bei mittelschwerer bis schwerer Parodontitis als Manifestation von Systemerkrankungen gegeben.

Für den gezielten Einsatz der adjuvanten systemischen Antibiotikatherapie stehen eine Vielzahl verschiedener Antibiotika unterschiedlicher Stoffgruppen zur Verfügung, die einzeln als Monotherapie oder in Kombination angewendet werden können. Die Auswahl sollte dabei stets auf der Grundlage einer mikrobiologischen Analyse erfolgen. Mit der Kombination von Amoxicillin/Metronidazol kann ein sicherer, vorhersagbarer, klinischer zusätzlicher Nutzen bzw. Erfolg erzielt werden. Um einen Therapieerfolg zu erreichen, ist es unabdingbar, dass die Anwendung der Antibiotika in Kombination mit der konventionellen mechanischen Parodontaltherapie erfolgt.

Periodontitis is an infection disease in terms of an opportunistic infection. Depending on the characteristric of the disease different periodonto-pathogenic bacteria are organized in a biofilm and contribute to the infection. The mechanical periodontal therapy alone cannot eliminate all the bacteria. This may lead to clinical failures and relapses. Therefore, in some cases it is necessary to support the periodontal treatment with a systemic administration of antibiotics. Nevertheless, an application of systemic antibiotics as a matter of routine has to be declined. In cases of plaque-associated gingivitis and in most forms of chronic periodontitis systemic antibiotics do not provide any additional benefit. An indication for the additional application of antibiotics in periodontal therapy is given only in the following situations: Aggressive and/or severe chronic periodontitis, therapy-resistant or refractory periodontitis, medium to severe periodontitis in systemic diseases.

Different antibiotics are recommended in connection with the periodontal therapy i. e. monodrug therapy and combination therapy. The selection of a bacteria-specific antibiotic regime should be based on a microbiological analysis prior to the medication. At the time being, a predictable clinical benefit or success, respectively, can be achieved by a combination of amoxicillin/metronidazol. In any case, the administration of antibiotics should always be combined with the conventional mechanical periodontal treatment.

Schlüsselwörter

Parodontitis - systemische Antibiotika - Parodontitistherapie - Effektivität - klinischer Erfolg

Key words

Periodontitis - Systemic Antibiotics - Periodontal Therapy - Efficacy - Clinical Success

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