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DoxycyclineRECOMMENDED EMPIRIC THERAPY OF SELECTED DENTAL INFECTIONS 1. Addy M, Renton-Harper P. Local and systemic chemotherapy in the management of periodontal disease: an opinion and review of the concept. J Oral Rehabil 1996; 23: 219-31. American Academy of Periodontology. Statement on Periostat; 20 mg doxycycline hyclate capsules for oral administration as an adjunct to scaling and root planning for the treatment of adult periodontitis. : perio resources-products periostat 3. ADA Council on Scientific Affairs. Antibiotic use in dentistry. JADA 1997; 128: 648. Axelsson P. Current role of pharmaceutical in prevention of caries and periodontal disease. Int Dent J 1993; 43: 473-82. Baker KA, Fotos PG. The management of odontogenic infections. Dent Clin North 1994; 38: 689-706. Barr CE. Practical considerations in the treatment of the HIV-infected patient. Dent Clin North 1994; 38: 403-23. Berge TI. Incidence of large third-molar-associated cystic lesions requiring hospitalization. Acta Odontol Scand 1996; 54: 327-31. Blondel-Hill E, Nigrin J. Guide to antimicrobial susceptibility testing & reporting. 3rd ed. Dynacare Kasper Medical Laboratories BC Children's Hospital. 2005. 9. Bridgeman A, Wiesenfeld D, Newland S. Anatomical considerations in the diagnosis and management of acute maxillofacial bacterial infections. Aust Dent J 1996; 41: 238-45. Broughton RA. Nonsurgical management of deep neck infections in children. Pediatr Infect Dis J 1992; 11: 14-8. Caton J, Blieden T, Adams D, et al. Subantimicrobial doxycycline therapy for periodontitis. J Dent Res 1997; 76: 177 Abstract #1307 ; . 12. Caton J, Ciancio S, Crout R, et al. Adjunctive use of subantimicrobial doxycycline therapy for periodontitis. J Dent Res 1998; 77: 1001 Abstract #2957 ; . 13. Chow AW, Roser SM, . Brady FA. Orofacial odontogenic infections. Ann Intern Med 1978; 88: 392-402. Chow AW. Life-threatening infections of the head and neck. Clin Infect Dis 1992; 14: 991-1004. Ciancio S. Expanded and future use of mouthrinses. JADA 1994; 125: 29S-32. Ciancio S. Use and abuse of antibiotics in periodontal therapy. Dent Econ 1993; 98-100. 17. Douglass CW, Fox CH. The emerging field of oral pharmaceuticals. JADA 1994; 125: 2S-4. Droz D, Koch L, Lenain A, et al. Bacterial endocarditis: results of a survey in a children's hospital in France. Br Dent J 1997; 183: 101-5. Echeverria JJ, Manau GC, Guerrero A. Supportive care after active periodontal treatment. J Clin Periodontol 1996; 23: 898-905. Edlund C, Bjorkman L, Ekstrand J, et al. Resistance of the normal human microflora to mercury and antimicrobials after exposure to mercury from dental amalgam fillings. Clin Infect Dis 1996; 22: 944-50. Ehrenfeld M. Clindamycin in the treatment of dental infections. In: Zambrano D. Clindamycin in the treatment of human infections. Kalamazoo MI: Pharmacia and Upjohn; 1997: 12-1-25. 22. Fine D. Evaluation of antimicrobial mouthrinses and their bactericidal effectiveness. JADA 1994; 125: 11S-9. Firatli E, Unal T, Onan U, et al. Antioxidative activities of some chemotherapeutics. A possible mechanism in reducing gingival inflammation. J Clin Periodontol 1994; 21: 680-3. Flemming TF, Millan E, Karch H, et al. Differential clinical treatment outcome after systemic metronidazole and amoxicillin in patients harboring actinobacillus actinomycetemcomitans and or porphyromonas gingivalis. J Clin Periodontol 1998; 25: 380-7. Genco RJ. Pharmaceutical and periodontal diseases. JADA 1994; 125: 11S-9. Genco RJ. Using antimicrobial agents to manage periodontal diseases. JADA 1991; 122: 31-8. Gibson M, Wilson M, Strahan D, et al. Preliminary evaluation of the use of methylene blue, a redox dye, in the treatment of chronic periodontitis. Clin Infect Dis 1993; 16: S411-3. 28. Gilmore WC, Jacobus NV, Borbach SL, et al. A prospective double-blind evaluation of penicillin versus clindamycin in the treatment of odontogenic infections. J Oral Maxillofac Surg 1988; 46: 1065-70. Golub LM, Wolff M, Roberts S, et al. Treating periodontal diseases by blocking tissue-destructive enzymes. JADA 1994; 125: 163-71. Greenspan JS. Periodontal complications of HIV infection. Compend Contin Educ Dent 18: S694-8. 31. Greenstein G, Berman C, Jaffin R. Chlorhexidine; an adjunct to periodontal therapy. J Periodontol 1986; 57: 370-7. Greenwell H, Bissada NF. Emerging concepts in periodontal therapy. Drugs 2002; 62: 2581-7. Grenby TH. The use of sanguinarine in mouthwashes and toothpaste compared with some other antimicrobial agents. Br Dent J 1995; 178: 254-8. Haas DA, Epstein JB, Eggert FM. Antimicrobial resistance: dentistry's role. J Can Dent Assoc 1998; 64: 496-502.Connecticut through various health coverage plans. Fallon Community Health Plan, which has more than 190, 000 members, is one of America's foremost managed care plans. 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Journal of Adolescent Health, 20, 377-383; See Alan Guttmacher Institute. 1994 ; . Sex and America's Teenagers. New York, NY: Alan Guttmacher Institute. 19 Mott, F.L. & Jaurin, R.J. 1988 ; . Linkages between sexual activity and alcohol and drug use among American adolescents. Family Planning Perspectives, 20 3 ; 128-136; Leigh, B. C., Schafer, J., & Temple, M. T. 1995 ; . Alcohol use and contraception in first sexual experiences. Journal of Behavioral Medicine, 18 1 ; , 81-95; Kinsman, S. B., Romer, D., Furstenberg, F. F., & Schwarz, D. F. 1998 ; . Early sexual initiation: The role of peer norms. Pediatrics, 102 5 ; , 118-1192; See Brooks-Gunn, J., Boyer, C. B., & Hein, K. 1988 ; . Preventing HIV infection and AIDS in children and adolescents: Behavioral research and intervention strategies. American Psychologist, 43 11 ; , 958-964. 20 Besharov, D.J, & Gardiner, K.N. 1997 ; . Trends in teen sexual behavior. Children and Youth Services Review, 19 5 6 ; , 341-367 21 CASA analysis of data from the 1997 Youth Risk Behavior Survey. 22 Michael, M. 1999 ; . Doing drugs: Two teens. Two lives. Two stories. Sex, Etc: A Website byTeens forTeens. Newark, NJ: The Network for Family Life Education, Rutgers University. Retrieved from the World Wide Web, 5 12 99: : rci tgers ~sxetc articles twoteens . 23 Kinsman, S. B., Romer, D., Furstenberg, F. F., & Schwarz, D. F. 1998 ; . Early sexual initiation: The role of peer norms. Pediatrics, 102 5 ; , 118-1192. 24 Mott, F. L., & Jaurin, R. J. 1988 ; . Linkages between sexual activity and alcohol and drug use among American adolescents. Family Planning Perspectives, 87, 141-147. 25 Rosenbaum, E., & Kandel, D. 1990 ; . Early onset of adolescent sexual behavior and drug involvement. Journal of Marriage and the Family, 52, 783-798. 26 Rosenbaum, E., & Kandel, D. 1990 ; . Early onset of adolescent sexual behavior and drug involvement. Journal of Marriage and the Family, 52, 783-798. 27 It is important to note that the teens in this study who used substances were more likely to remain virgins than they were to become sexually active, but they were more likely to become sexually active than teens who did not use alcohol or drugs. Mott, F.L. & Jaurin, R.J. 1988 ; . Linkages between sexual activity and alcohol and drug use among American adolescents. Family Planning Perspectives, 20 3 ; 128-136. 28 Mott, F. L., & Jaurin, R. J. 1988 ; . Linkages between sexual activity and alcohol and drug use among American adolescents. Family Planning Perspectives, 87, 141-147. 29 CASA analysis of data from the 1997 Youth Risk Behavior Survey. 30 CASA analysis of data from the 1997 Youth Risk Behavior Survey. 31 Shrier, L.A., Emans, S.J., Woods, E.R., & DuRant, R.H. 1996 ; . The association of sexual risk behaviors and problems drug behaviors in high school students. Journal of Adolescent Health, 20, 377-383; Duncan, S. C., Strycker, L. A., & Duncan, T. E. 1999 ; . Exploring associations in developmental trends of adolescent substance use and risky sexual behavior in high-risk populations. Journal of Behavioral Medicine, 22 1 ; , 21-34; Shrier, L. A., Emans, S. J., Woods, E. R., & DuRant, R. H. 1996 ; . The association of sexual risk behaviors and problem drug behaviors in high school students. Journal of Adolescent Health, 20, 377-383. 32 CASA analysis of data from the 1997 Youth Risk Behavior Survey. 33 Michael, M. 1999 ; . Doing drugs: Two teens. Two lives. Two stories. Sex, Etc: A Website byTeens forTeens. Newark, NJ: The Network for Family Life Education, Rutgers University. Retrieved from the World Wide Web, 5 12 99: : rci tgers ~sxetc articles twoteens . 34 See Besharov, D. J., & Gardiner, K. N. 1997 ; . Trends in teen sexual behavior. Children and Youth Services Review, 19 5 6 ; , 341-367. 35 Valles, J.R., Zimmerman, M.A. & Newcomb , M.D. 1998 ; . Sexual risk behavior among youth: Modeling the influence of prosocial activities and socioeconomic factors. Journal of Health and Social Behavior, 39 3 ; , 237-253; Noell, J. et al 1993 ; . Problematic sexual situations for adolescents: alcohol and unsafe sex. Health Values 17 6 ; , 4049; Besharov, D.J, & Gardiner, K.N. 1997 ; . Trends in teen sexual behavior. Children and Youth Services Review, 19 5 6 ; , 341-367; Leigh, B.C., et al 1994 ; . Sexual behavior of American adolescents: Results from a U.S. national survey. Journal of Adolescent Health, 15 2 ; , 117-125; Centers for Disease Control and Prevention. 1998 ; . Trends in sexual risk behaviors among high school students -- United States, 1991-1997. Morbidity and Mortality Weekly Report, 47 36 ; , 749-752. 36 Shrier, L. A., Emans, S. J., Woods, E. R., & DuRant, R. H. 1996 ; . The association of sexual risk behaviors and problem drug behaviors in high school students. Journal of Adolescent Health, 20, 377-383; Hingson, R. W, because doxycycline mono. CONCLUSIONS -- We have previously demonstrated that improved metabolic control, as well as AHT, may retard the development of glomerular structural changes in microalbuminuric type 1 diabetic patients 13, 14 ; . To evaluate the possible additional role of genetic susceptibility, we have now extended the study of these patients by investigating the relative influence of the I D ACE-gene polymorphism on the progression of diabetic glomerulopathy. Despite the small number of patients, we find that those heterozygous or homozygous for the D-allele show an increased progression in BMT and overall diabetic glomerulopathy index. To our knowledge, such data have not been presented earlier. However, our results are in agreement with several 6, 9 ; but not all 10, 11 ; clinical studies, using either progression of microalbuminuria or decline Figure 3--Overall index DGP at baseline and follow-up in 8 patients with the II genotype and in glomerular filtration rate as end points. 22 patients with the ID and DD genotypes control mean 58.2 8.8 ; . , Patients with AHT , patients In addition, in the meta-analysis by Fuji; sawa et al. 12 ; that included 4, 773 diawithout AHT. betic patients, it was suggested that the D-allele has a major impact on susceptipatients with the ID and DD genotypes. At index DGP P 0.02 ; was seen in patients bility for nephropathy. baseline before treatment ; AER was simi- without AHT, as compared with those with Our data also indicate that the influence lar between groups, whereas s-ACE was AHT Figs. 1 and 3 ; . Thus, to study the of the D-allele is independent of AHT, at least higher in the ID and DD group Table 1 ; . independent relationship between the on the progression of BMT. More imporAt final follow-up median, AER was 11 ACE genotype and BMT over 24 months tantly, young microalbuminuric patients het 6134 ; g min in the II genotype group and index DGP over 24 months, multi- ero- or homozygous for the D-allele, but and 14 4187 ; g min in the ID and DD ple regression analyses were performed, without AHT, seem to have a more marked genotype group P 0.32 ; . also including AHT and mean HbA1c dur- progression of diabetic glomerulopathy durMean HbA1c and mean systolic and ing the study as independent variables. It ing a 2-year period than those with AHT. It diastolic BPs, calculated from measure- was found that mean HbA1c P 0.001 ; , is noteworthy that the structural changes at ments every 6 months, were similar in no AHT P 0.001 ; , and ID and DD baseline were in the same range in the two patients with the II and ID and DD geno- genotype P 0.01 ; had independent sig- subgroups. This observation is compatible types Table 1 ; . nificant influences on BMT over 24 with the idea that the ACE-polymorphism months. When using DGP-index as the may not be associated with the initialization Morphological results dependent variable, only mean HbA1c had of nephropathy. Tarnow et al. 19 ; have preBMT, matrix star volume, and overall DGP a significant influence on this morpho- viously suggested that the ACE-inhibitor capindex, i.e., index DGP BMT 10 V v metric measure P 0.01 ; . ACE genotype topril may have a less renal-protective effect mat glom ; % matrix star volume ; were and AHT tended to have an independent in macroalbuminuric type 1 diabetic patients similar at baseline but increased during influence on the change in DGP-index P with the D-allele. In that study, the degree of follow-up in patients with ID and DD 0.05 and 0.07, respectively ; . albuminuria was unchanged despite captogenotypes only Figs. 13 ; . Vv mes glom ; and Vv mat glom ; did not increase in any group Table 2 ; . The increase in BMT over Table 2--Baseline and follow-up structural data in patients with the II genotype and the ID and 24 months was significantly higher in ID DD genotypes and DD genotypes as compared with II genotype P 0.01 ; , and so was the II genotype ID and DD genotypes increase in index DGP over 24 months Baseline Follow-up Baseline Follow-up P 0.03 ; . The increase in matrix star vol584 123 590 126 * ume over 24 months tended to be higher BMT nm ; 21.6 5.4 21.9 in patients with ID and DD genotypes Vv mes glom ; % ; Vv mat glom ; % ; 11.9 2.7 13.0 P 0.09 ; . 26.9 8.8 30.0 In patients with ID and DD genotypes, Matrix star volume m3 ; Index DGP 96.7 25.0 102.0 * an increased progression in basement membrane thickening P 0.001 ; and in Data are means SD. * P 0.001; P 0.01. Often, periodontal pockets of 4 mm more in depth remain after clinical efforts to eliminate them with SRP and or periodontal surgery. Such residual pockets often are present in patients who have undergone complex restorative therapy after conventional, surgical periodontal therapy has been completed. Retreating these areas surgically can reduce oral esthetic acceptability and cause patients to have concerns about their appearance. Numerous methods have been devised to deliver local antibiotics to subgingival Dr. Christensen is areas. One of co-founder and senior consultant of the most simClinical Research ple and logical Associates, 3707 N. products is Canyon Road, Suite No. 7A, Provo, Utah Atridox Block 84604, and is a Drug ; . This member of JADA's editorial board. He product is has a master's dedoxycycline hygree in restorative clate in a vehidentistry and a doctorate in education cle of polylactic and psychology. He acid. It is is board certified in prosthodontics. placed into Address reprint reperiodontal quests to Dr. pockets after it Christensen and erythromycin. The american journal of medicine. Para obtener informacin ms detallada sobre la cobertura de medicamentos de prescripcin de PartnershipAdvantage, por favor revise su Explicacin de la Cobertura EOC ; de PartnershipAdvantage para 2007 y otros materiales del plan. 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Thritis with Antibiotics, British Journal of Rheumatology, 1998, 37 7 ; , 717-720. 201.Smith, GN Jr, Yu, LP Jr, Brandt, KD, Capello, WN, Oral administration of doxycycline reduces collagenase and gelatinase activities in extracts of human osteoarthritic cartilage, Journal of Rheumatology, 1998, 25 3 ; , 532-535. 202.Tilley, BC, Alarcon, GS, Heyse, SP, Trentham, DE, Neuner, R, Kaplan, DA, Clegg, DO, Leisen, JC, Buckley, L, Cooper, SM, Duncan, H, Pillemer, SR, Tuttleman, M, Fowler, SE, Minocycline in rheumatoid arthritis: A 48-week, double-blind, placebo-controlled trial, MIRA Trial Group, Annals of Internal Medicine, 1995, 122 2 ; , 81-89. 203.Trentham, DE, Dynesius-Trentham, rheumatoid arthritis, Antibiotic therapy for rheumatoid arthritis: Scientific and anecdotal appraisals, Rheumatic Diseases Clinics of North America, 1995, 21 3 ; , 817-834. 204.Wilson, C, Senior, BW, Tiwana, H, Caparros-Wanderley, W, Ebringer, A, Antibiotic sensitivity and proticine typing of Proteus mirabilis strains associated with rheumatoid arthritis, Rheumatology International, 1998, 17 5 ; , 203-205. 205.Yu, LP Jr, Burr, DB, Brandt, KD, O'Connor, BL, Rubinow, A, Albrecht, M, Effects of oral doxycycline administration on histomorphometry and dynamics of subchondral bone in a canine model of osteoarthritis, Journal of Rheumatology, 1996, 23 1 ; , 137-142. 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Both groups were comparable with regard to age, sex and the most important variables influencing effectiveness of the procedure, i.e. primary malignancy and stage of metastatic involvement of the pleura. Efficiency of pleurodesis was prospectively assessed. The analysis of short-term effectiveness of pleurodesis in the first 33 patients has shown a highly significant difference in favor of talc powder p 0.009 this difference was the reason for terminating the randomization. Further observation has revealed in the doxycycline group an increasing number of patients with fluid reaccumulation, as time went by; this was not observed in the talc group. A statistical analysis of the long-term effectiveness of both agents studied has shown a more significant difference in favor of the talc powder p 0.00003 ; . Talc powder is superior to doxycycline in achieving pleurodesis in patients with malignant pleural effusion, in both short- and long-term observations. 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