Adult - Refractory Periodontitis
- Progressive destruction of periodontal attachment despite diligent mechanical treatment.
- If not responding, consider referral.
- Since Aggregatibacter may be found in up to 1/3 of cases, clindamycin not optimal.
First line therapy
Personal plaque/calculus control and professional debridement essential
Stage I or II adult periodontitis
| Empiric Therapy | |
|---|---|
| Tetracycline | 250mg PO qid x 7 days |
| or | |
| Doxycycline | 100mg PO bid x 7 days |
| or | |
| Doxycycline (Periostat®) | 20mg PO bid x 3-12 months |
Stage III or IV adult and juvenile periodontitis
| Empiric Therapy | |
|---|---|
| [Amoxicillin | 500mg PO tid x 7-14 days |
| + | |
| Metronidazole] | 500mg PO bid x 7-14 days |
| or | |
| Amoxicillin-clavulanate | 875mg PO bid x 7-14 days |
Penicillin/amoxicillin allergy
| Empiric Therapy | |
|---|---|
| [Cefuroxime axetil | 500mg PO bid x 7-14 days |
| or | |
| Cefuroxime | 750mg IV/IM IV q8h x 7-14 days |
| or | |
| Ceftriaxone] | 1g IV/IM daily x 7-14 days |
| + | |
| Metronidazole | 500mg IV/PO bid x 7-14 days |
Cefuroxime and ceftriaxone allergy
| Empiric Therapy | |
|---|---|
| Levofloxacin | 750mg IV/PO daily x 7-14 days |
| + | |
| Metronidazole | 500mg IV/PO bid x 7-14 days |