Development of resistance of mutans streptococci and Porphyromonas gingivalis to chlorhexidine digluconate and amine fluoride/stannous fluoride-containing mouthrinses, in vitro.

OBJECTIVE: The aim if this study was to determine the minimal inhibitory concentrations of chlorhexidine digluconate and an amine fluoride/stannous fluoride-containing mouthrinse against Porphyromonas gingivalis and mutans streptococci during an experimental long-term subinhibitory exposition. MATERIAL AND METHODS: Five P. gingivalis strains and four mutans streptococci were subcultivated for 20-30 passages in subinhibitory concentrations of chlorhexidine digluconate or an amine fluoride/stannous fluoride-containing mouthrinse. RESULTS: Pre-passaging minimal inhibitory concentrations for chlorhexidine ranged from 0.5 to 2 mg/l for mutans streptococci and from 2 to 4 mg/l for the P. gingivalis isolates. For the amine fluoride/stannous fluoride-containing mouthrinse minimal inhibitory values from 0.125 to 0.25% for the mutans streptococci and from 0.063 to 0.125% for the P. gingivalis isolates were determined. Two- to fourfold increased minimal inhibitory concentrations against chlorhexidine were detected for two of the five P. gingivalis isolates, whereas no increase in minimal inhibitory concentrations was found for the mutans streptococci after repeated passaging through subinhibitory concentrations. Repeated exposure to subinhibitory concentrations of the amine fluoride/stannous fluoride-containing mouthrinse did not alter the minimally inhibitory concentrations of the bacterial isolates tested. CONCLUSION: Chlorhexidine and the amine fluoride/stannous fluoride-containing mouthrinse are effective inhibitory agents against the oral bacterial isolates tested. No general development of resistance against chlorhexidine or the amine fluoride/stannous fluoride-containing mouthrinse was detected. However, some strains showed potential to develop resistance against chlorhexidine after prolonged exposure. CLINICAL RELEVANCE: The use of chlorhexidine should be limited to short periods of time. The amine fluoride/stannous fluoride-containing mouthrinse appears to have the potential to be used on a long-term basis.

Combinatorial effects of amoxicillin and metronidazole on selected periodontal bacteria and whole plaque samples.

OBJECTIVE: The aim of the present study was to analyze in vitro the combinatorial effects of the antibiotic combination of amoxicillin plus metronidazole on subgingival bacterial isolates. DESIGN: Aggregatibacter (Actinobacillus) actinomycetemcomitans, Prevotella intermedia/nigrescens, Fusobacterium nucleatum and Eikenella corrodens from our strain collection and subgingival bacteria isolated from patients with periodontitis were tested for their susceptibility to amoxicillin and metronidazole using the Etest. The fractional inhibitory concentration index (FICI), which is commonly used to describe drug interactions, was calculated. RESULTS: Synergy, i.e. FICI values ≤ 0.5, between amoxicillin and metronidazole was shown for two A. actinomycetemcomitans (FICI: 0.3), two F. nucleatum (FICI: 0.3 and 0.5, respectively) and one E. corrodens (FICI: 0.4) isolates. Indifference, i.e. FIC indices of >0.5 but ≤4, occurred for other isolates and the 14 P. intermedia/nigrescens strains tested. Microorganisms resistant to either amoxicillin or metronidazole were detected in all samples by Etest. CONCLUSION: Combinatorial effects occur between amoxicillin and metronidazole on some strains of A. actinomycetemcomitans, F. nucleatum and E. corrodens. Synergy was shown for a few strains only.

Antimicrobial susceptibility of periodontopathogenic bacteria.

OBJECTIVES: The aim of this study was to evaluate the resistance profiles of Aggregatibacter (Actinobacillus) actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia/Prevotella nigrescens and to detect possible changes in antibiotic resistance over the time period of 1991-2005. METHODS: A. actinomycetemcomitans (125 strains), P. gingivalis (152 strains) and P. intermedia/P. nigrescens (326 strains) isolated during the years 1991-2005 were tested for their susceptibility to amoxicillin/clavulanic acid, clindamycin, metronidazole, phenoxymethylpenicillin and tetracycline using the Etest. RESULTS: No antibiotic resistance was detected in P. gingivalis, whereas a few isolates of P. intermedia were not susceptible to clindamycin (0.9%), phenoxymethylpenicillin (13.5%) or tetracycline (12.6%). Amoxicillin/clavulanic acid, tetracycline and metronidazole were the most effective antibiotics against A. actinomycetemcomitans with 0%, 0.8% and 20.8% non-susceptible isolates, respectively. However, 88% of the A. actinomycetemcomitans isolates were non-susceptible to phenoxymethylpenicillin and 88% to clindamycin. When strains isolated in the years 1991-94 were compared with those isolated in the years 2001-04, there was no statistically significant difference in the percentage of A. actinomycetemcomitans strains non-susceptible to clindamycin, metronidazole or phenoxymethylpenicillin, or in the percentage of P. intermedia strains non-susceptible to phenoxymethylpenicillin or tetracycline (P > 0.4 each). CONCLUSIONS: Increasing antibiotic resistances in periodontopathogenic bacteria are not yet a problem in the Northern part of Switzerland.

Antimicrobial activity of Mahonia aquifolium and two of its alkaloids against oral bacteria.

Extracts or alkaloids isolated from Mahonia aquifolium exhibit antimicrobial activity against Gram-positive and Gram-negative bacteria, fungi, and protozoa. In this study the bacteriostatic and bacteriocidal activities of a M. aquifolium extract and two of its major alkaloids, berberine chloride and oxyacanthine sulphate, were tested in vitro against nine different oral bacteria. Minimum inhibitory concentrations were in the range from < or = 0.0031% to 0.1993% for the M. aquifolium extract, from 0.002% to > 0.125% for berberine chloride, and from 0.0156% to > 0.0625% for oxyacanthine sulphate. The values for the minimum bactericidal concentrations were in the same range, indicating that the test substances most probably acted in a bactericidal manner. The most susceptible bacterium against all three test substances was Porphyromonas gingivalis.