Schmidt Edgard F, Bretz Walter A
N Y State Dent J. 2007 Jun-Jul;73(4):40-5.
The strong association of subgingival anaerobic bacteria, such as Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia, with destructive periodontal disease has been well documented in the literature. Several double-blind studies have also shown the beneficial use of systemic antimicrobials that are active against these microorganisms in conjunction with conventional periodontal treatment, especially when periodontal abscesses and/or suppuration upon probing are present. Four cases with periodontal abscesses were treated with scaling/root planing in conjunction with systemic azithromycin. Partial improvement led to retreatment with two additional courses of azithromycin. Bone formation was noted on periapical radiographs after the patients took additional courses of azithromycin. In view of the benefits of using additional courses of azithromycin in the treatment of destructive periodontal disease, we conclude that the single course of systemic antimicrobials currently used in periodontal therapy may be insufficient to reach necessary therapeutic levels in infected sites.
龈下厌氧菌，如牙龈卟啉单胞菌、具核梭杆菌和福赛坦氏菌，与破坏性牙周病之间的密切关联在文献中已有充分记载。多项双盲研究还表明，对这些微生物有活性的全身用抗菌药物与传统牙周治疗联合使用具有益处，尤其是在存在牙周脓肿和/或探诊时有化脓的情况下。4例牙周脓肿患者接受了龈上洁治/根面平整术，并联合使用全身用阿奇霉素进行治疗。部分改善后，又额外进行了两个疗程的阿奇霉素再治疗。患者接受额外疗程的阿奇霉素治疗后，根尖片显示有骨形成。鉴于额外疗程的阿奇霉素在治疗破坏性牙周病方面的益处，我们得出结论，目前牙周治疗中使用的单疗程全身用抗菌药物可能不足以在感染部位达到必要的治疗水平。
