Systemic Antibiotics

Because Aa predominates and it is invasive, systemic antibiotics will enhance the effectiveness of traditional periodontal therapy. The antibiotic will be secreted into the pocket and adequate concentrations will be found in serum and gingival crevicular fluid (GCF). Tetracycline or doxycycline, a synthetic derivative, has been shown to be moderately effective against organisms associated with LJP when used in conjunction with mechanical therapy. Advantages of doxycycline are that it does not contraindicate dairy products like generic tetracycline, and lower dosages are effective. Compliance is improved because the regime is simpler and shorter; however, it is more expensive than generic tetracycline.

A combination antibiotic regime of metronidazole plus amoxicillin is also effective; however, it cannot be used in patients with penicillin sensitivities. It is active against the causative pathogens and does not foster development of opportunistic organisms. Dosages of each drug can be decreased and the duration shortened when a combination regime is prescribed. Whenever selecting antibiotics, consult a current drug reference for recommended dosages, indications, contraindications, precautions, and side effects.

Tetracycline Fiber therapy or topical tetracycline is not as effective as systemic antibiotics in treatment of LJP.  The invasive nature of Aa reduces the effect of locally-delivered antibiotics.17,18