Drugs in periodontal diseases have antimicrobial properties and have the ability to improve resistance against infection. These antimicrobials can be used systemically or locally. In earlier times clinical success of periodontal therapy included oral hygiene education and surgical or mechanical root debridement to remove sub-gingival pathology. In severe cases, chemotherapeutic agents may prove beneficial. Introduction The drugs have a long history of use in the treatment of various human diseases. Antibiotics either suppress the growth of microorganism or destroy them. Drugs used to treat periodontal disease can have antimicrobial properties or those that improve host resistance. These antimicrobials can be used systemically or locally. Traditionally the foundation of clinical success in periodontal therapy included education of the patient in oral hygiene, surgical and mechanical root debridement to remove sub-gingival pathology and their accretions from root surface, and supportive periodontal therapy.However, in certain types of periodontal disease including chronic advanced periodontitis, refractory periodontitis, aggressive periodontitis and periodontitis as a manifestation of systemic disease, adjunctive chemotherapeutic agents may be beneficial to control the disease1. Guidelines For Use Of Antibiotics In Periodontal Therapy The clinical diagnosis and situation dictate the need for antibiotic therapy as an adjunct in controlling active periodontal disease. Antibiotics are selected based on the microbial composition of plaque. Antibiotics have been shown to have value in reducing the need for periodontal surgery in patients with chronic periodontitis who are medically compromised. Also, cases of aggressive periodontitis and refractory disease may require antimicrobial therapy2. However, drugs should not be used as a monotherapy. It must be a part of comprehensive treatment plan. Therapy should also include debridement of root surfaces, optimal oral hygiene, and frequent supportive periodontal therapy. Serial And Combination Drug Therapy Since periodontal diseases contain a wide variety of microorganisms, a single antibiotic cannot eliminate all bacteria. Therefore, it may be beneficial to use more than one antibiotic, serially or in combination3. Bacteriostatic antibiotics should not be given in combination with bactericidal ones, since they do not function well. If both types of drugs are required, they should be given serially i.e. one after the other. E.g. Tetracycline (bacteriostatic) should not be combined with amoxicillin (bactericidal). However, amoxicillin can be given in combination with metronidazole. MTZ with ciprofloxacin and MTZ with Augmentin are very effective drug combinations against refractory and aggressive periodontitis3,4,5. Systemically Used Antibiotics In Periodontics These are naturally occurring, semi-synthetic or synthetic types of antimicrobial agents that destroy or inhibit the growth of selective microorganisms, usually at low concentrations. The most common antibiotics used in periodontics have been listed below.TetracyclinesTetracyclines are the most widely prescribed agents for periodontal therapy and are broad-spectrum antibiotics. Tetracyclines are bacteriostatic in action and retard the growth of organisms by inhibiting protein synthesis. The adult dose for tetracycline is 250–500 mg q.i.d, doxycycline 100 mg o.d and minocycline 100 mg b.d. These antibiotics are secreted in the crevicular fluid in higher concentrations and are effective against a number of oral gram-negative and gram-positive cocci and bacilli6. These antibiotics are indicated in the treatment of generalized and localized aggressive periodontitis as well as periodontitis refractory to treatment. However, with the emergence of resistant species of bacteria, tetracyclines are currently replaced by more effective combination antibiotic therapy7. Adverse effects of tetracycline include retardation of bone growth (transient
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