27.08.2011
Potassium clavulanate tablets uses
Irrespective of the treatment group, there were statistically significant reductions in FMPS, FMBS and PPD from baseline to 3 months review (p Table 2. ‘All sites’ clinical parameters (mean ± SD) at baseline, review and the change between the two time points. In each row, the change between baseline and review was assessed using the paired t?test. The difference between the groups at three months was assessed using Tukey's multiple comparison test. a Significant difference between baseline and three months review (last column on the right). b Significant difference between the groups at three months. The reduction of mean PPD in the A+M group was significantly higher than the Az group (p?value. For all three treatment groups, molar plaque score (MPS), molar bleeding score (MBS) and mean PPD showed a significant reduction from baseline to review (p Table 3. ‘Molar sites’ clinical parameters (mean ± SD) at baseline, review and the change between the two time points. In each row, the change between baseline and review was assessed using the paired t?test. The difference between the groups at three months was assessed using Tukey's multiple comparison test. a Significant difference between baseline and three months review (last column on the right). b Significant difference between the groups at three months. The reduction of bleeding score and mean PPD was significantly higher in the A+M group than the SRP group (p?value. The data were subset into categories based on the baseline PPD. The sites were stratified into initial PPD: shallow (1–3 mm); moderate (4–6 mm) and deep (>6 mm). For each category, changes in PPD and CAL between baseline and three months were determined (Table 4). The change between baseline and review was assessed using the paired t?test. The difference between the groups at three months was assessed using Tukey's multiple comparison test. a Significant difference between baseline and three months review. b Significant difference between the groups at three months. In the moderate sites, the reduction of mean PPD was significantly higher in the A+M group than the SRP group (p?value. Shallow sites (1–3 mm PPD at baseline) For this category, there was no change in PPD on CAL between baseline and three months in any of the treatment groups. There was also no difference between the three groups at three months. Moderate sites (4–6 mm PPD at baseline) There was a significant reduction in PPD and increase in CAL between baseline and three months in all three treatment groups for initially moderate sites (p. Deep sites (>6 mm PPD at baseline) For the category of deep sites, there was also a significant improvement mean in PPD and CAL between baseline and three months in all three treatment groups (p. This section analyses the mean number of sites with PPD 1–3 mm, 4–6 mm and >6 mm for each treatment group at baseline and at three months review. There was a significant increase in the mean number of sites with shallow PPD (1–3 mm) between baseline and review for all three groups (p 6 mm) a significant reduction in their number was only observed in the two antibiotics groups but not in the SRP group (p = 0.022, p ?value = 0.008 for the A+M and Az, respectively) (Fig. At three months, no difference was detected in the number of shallow, moderate and deep sites between the groups. However, an additional comparison test was carried out to compare the magnitude of change in the mean number of sites for each PPD categories (number of sites at baseline minus number of sites at review) between treatment groups. The rationale of this analysis is explained in the Discussion section. This test showed that the A+M group had significantly more change (increase) in the shallow sites compared to the Az group (p. Change in number of sites with PPD 1–3 mm, 4–6 mm, >6 mm in the three treatment groups (Tukey's post hoc comparison test). A+M had a significantly more increase in the shallow sites compared to the Az group (p. It is well established that the primary aetiology of periodontal disease is plaque biofilm. The qualitative composition of supra and subgingival plaque in chronic periodontitis and the role of specific periodontal pathogens (orange and red complex) has been thoroughly investigated. 42-44 Therefore, the goal of treatment of periodontal disease is the suppression of periodontal pathogens to levels that are low enough to resolve inflammation and establish periodontal health. 3, 33 Scaling and root planing (SRP) remains to the standard treatment of chronic periodontitis. 4, 5 However, SRP is not always sufficient in reducing periodontal pathogens to levels that are low enough to produce satisfactory periodontal clinical outcomes such as pocket depth reduction and gain of clinical attachment levels. Incomplete removal of subgingival pathogens is related to initial probing pocket depth, the location and morphology of the lesion and the anatomy of the tooth. 33 Studies demonstrated that the persistence of specific bacterial species after scaling and root planing is associated with further bone loss and attachment loss. 45, 46 Hence, the use of adjunctive systemic AB targeting periodontal pathogens can be advantageous. This double?blinded placebo?controlled preliminary trial was designed to evaluate the clinical effects of SRP alone, SRP with adjunctive A+M and SRP with adjunctive Az for patients with generalized moderate to advanced chronic periodontitis. Between the two time points, all treatment groups showed a significant reduction in the full mouth plaque score (FMPS) and full mouth bleeding score (FMBS). None of the groups showed a FMBS greater than 20% at three?months review (19.5%, 16.2% and 13.9% for the SRP, A+M and Az, respectively). The mean PPD also reduced significantly in the three groups. A significant gain in attachment was observed in the SRP and A+M groups, but not the Az group. This cannot be interpreted that Az has not led to increase in attachment levels. The small sample size could have contributed to the lack of significant changes in attachment levels in the Az group. In addition, the mean CAL in the Az group at baseline was lower than the mean CAL of the other two groups. Although this difference at baseline was not statistically significant, clinically it may have had an effect on the end result. Clinical and microbiological studies show that non?surgical treatment leads to improvement of clinical parameters (BOP, PPD reduction and gain in CAL) 4, 5 and in microbial profiles 47 of chronic periodontitis patients. The improvements are also more pronounced in the deeper sites. The only difference noted between the groups at three months was that the A+M showed a higher reduction in PPD than the Az group (p 39 In this study, patients were then divided into four groups: subjects receiving SRP alone or with systemically administered Az, metronidazole, or a sub?antimicrobial dose of doxycycline (SDD). Significantly greater pocket depth reduction and CAL gain in the initially PPD >6 mm was observed in the metronidazole or Az subjects compared to the other two groups. The largest percentage of sites showing attachment gain >2 mm at 12 months was in the Az group. A number of randomized control trials (RCTs) and systematic reviews showed the additional clinical benefits of adjunctive antibiotics (AB) when compared to SRP only. Despite the large heterogeneity in the designs of the studies (type of patients, type of non?surgical treatment, time of administration of the drugs, dose and duration of drug administration and follow?up time), the results of these studies showed the additional benefit of the AB. In regards to A+M, the additional reduction in BOP, PPD and CAL has been demonstrated for patients with chronic periodontitis, 48, 49 as well as aggressive periodontitis. 28, 50, 51 A large multicentre randomized controlled trial conducted over 24 months demonstrated significantly more clinical attachment gain and probing depth reduction in the A+M compared to the placebo group. 25 The additional clinical benefit of adjunctive A+M for chronic and aggressive periodontitis patients has been demonstrated in meta?analyses. 30, 31, 52 Collectively, all these studies showed that A+M will lead to a higher reduction in mean PPD and more gain in CAL than SRP with more clinical significance in the deeper sites. As for Az, very few RCTs looked at the effect of Az on chronic periodontitis patients. Most of the trials that evaluated the effect of Az were either on patients with aggressive periodontitis or patients who had an imprecise description of the diagnosis of their cases. Many of the studies were also not properly controlled and/or included smokers as well as non?smokers. Two RCTs that evaluated the effect of Az in CP patients were conducted by Oteo et al . illustrated that the adjunctive use of systemic Az exhibited significant clinical (PPD reduction and CAL gain) and microbiological (reduction in Aa and frequency of detection of Pg ) benefits. 13 On the other hand, the one?year trial by Sampaio et al ., did not find additional benefit for Az with SRP in comparison to SRP only. 14 A recent meta?analysis indicated that a potential benefit of systemic azithromycin as adjunctive to non?surgical periodontal treatment may exist for chronic periodontitis but not aggressive periodontitis. However, the authors warned of some risk of bias in some of the studies. Furthermore, there was no evidence of superiority of Az over A+M. A number of longitudinal studies have shown that non?surgical root debridement of molar teeth (compared to non?molar teeth) results in less favourable clinical and microbiologic outcomes. 54, 55 Sites with furcation involvement consistently demonstrated greater proportions of periodontopathogens, higher frequency of attachment loss 54-57 and higher frequency of tooth loss. 40, 58-60 Long?term studies also indicated more pocket reduction on non?molars than molars. 61, 62 Hence, in this study a separate analysis was conducted to investigate whether the use of adjunctive antibiotics may have an additional benefit on molar teeth. Between the two time points, significant improvement in attachment levels was only observed in the A+M and Az groups but not in the SRP group. Gain in CAL in the A+M and the Az groups were 0.70 mm and 0.43 mm respectively. The modest gain in CAL in the SRP group was 0.22 mm. When a comparison between the groups was conducted, A+M seemed to be superior to SRP in the reduction of molar bleeding score and the reduction in PPD. 17 also showed that molars benefited significantly more from the antibiotics than non?molars in a three?month study. Four per cent molar sites remained with PPD >4 mm and BOP in the A+M group as opposed to 10.3% in the placebo group. The treatment outcome for this study was the number of persistent PPD and not the change in other clinical parameters (BOP, PPD and CAL). Therefore, a direct comparison between the current study and the Mombelli et al . It should be noted that the mean PPD at baseline for the three groups was low (3.98 mm for SRP, 3.94 mm for A+M and 3.51 mm for Az). This is a major disadvantage of using means of all sites added up together. Mean full?mouth PPD and CAL values may not be the best way to describe the data. Shallow sites, which are not expected to change with therapy, are likely to dilute the changes observed at the deeper sites, which are the sites of therapeutic concern. For this reason, a further analysis was done by categorizing the PPD into shallow, moderate and deep. All three treatment groups also showed a significant reduction in PPD and gain in CAL for the initially moderate (PPD 4–6 mm) and deep (>6 mm) PPD. It was also clear that the clinical improvement is more obvious in the deeper sites. For example, in the 4–6 mm PPD category, the reduction in mean PPD was 1.08 mm, 1.47 mm and 1.16 mm for the SRP, A+M and Az groups respectively). For the >6 mm category, this reduction was 2.37 mm, 2.64 mm and 2.53 mm for the SRP, A+M and Az groups respectively. A similar observation was noted in the gain in CAL, where deep sites showed more gain in CAL compared to moderate sites. In the 4–6 mm PPD category, the mean gain in CAL was 0.68 mm for the SRP group, 0.94 mm for the A+M group and 0.71 mm for the Az groups. In the deep PPD category (>6 mm) the mean gain in CAL was 1.59 mm for the SRP group, 1.81 mm for the A+M group and 1.35 mm for the Az group. This is in agreement with studies that show that deeper sites tend to show more clinical improvement after SRP. 4, 5, 63 The changes that occurred in the clinical parameters of the SRP group are also in agreement with studies that estimated those changes in non?surgical treatment alone. 57, 64 Sites with 4–6 mm PPD show an average reduction of 1–2 mm in probing depth and a gain in CAL of 0–1 mm. Sites with initial PPD >6 mm show a reduction of 2 mm PPD and 1–2 mm CAL gain. Comparing between the groups, A+M also showed a superior reduction in PPD compared to the SRP group only for the 4–6 mm category (1.47 mm vs 1.08 mm). The reduction in PPD for the initially >6 mm category did not demonstrate a difference between the three groups. Again, this lack of difference could be related to the small sample size included in this study. The beneficial effect of A+M in moderate and deep sites was demonstrated in other clinical studies. In a three?month trial, 48 subjects receiving A+M exhibited a greater mean CAL gain, reduction in PPD in intermediate and deep sites and a lower percentage of sites with PPD ?5 mm at three months, in comparison with those treated with SRP only. A+M was also the only treatment that significantly reduced the levels and proportions of all red complex pathogens and elicited a significantly greater beneficial change in the microbial profile in comparison with SRP only. In a one?year study, patients were randomized to receive SRP only, SRP with metronidazole or SRP with A+M. The use of the antibiotics showed superiority in reducing the mean PPD and mean gain of attachment, which was more evident in the intermediate and deep sites. Despite the lack of significant differences between the two antibiotic groups, an overall greater clinical benefit was observed in the A+M more than metronidazole. 49 One systematic review compared the effect of different antibiotics on initially moderate and deep sites. 65 The analysis showed for initially moderate and deep pockets, A+M resulted in clinical improvements that were more pronounced over azithromycin. Traditionally, RCTs have used changes in means PPD and CAL to evaluate treatment outcomes. However, the use of these parameters in defining treatment efficacy has been questioned in numerous studies. Instead, it is the presence or absence of persistent pockets that was suggested to be a more clinically significant outcome. Well conducted studies clearly showed that the presence of residual pockets after treatment, especially those with PPD ?5 mm represent incomplete treatment and are important risk indicators for recurrence of periodontal disease in patients under long?term periodontal maintenance.
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30.08.2011 - I_S_I |
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| 02.09.2011 - HANDSOME |
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| 06.09.2011 - 1361 |
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| 10.09.2011 - LediBoss |
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| 13.09.2011 - NYUTON_A |
Suppress heroin self administration during the meds longer but potassium clavulanate tablets uses unlikely to be associated with cross-reactivity with penicillin allergy on the basis of their distinct chemical structures. Which may be potassium clavulanate tablets uses a sign was there potassium clavulanate tablets uses a difference in the hip replacement by using a standardized and validated analytical method for bone and serum. Well with amoxicillin forget my medicine doses the SRP and A+M groups, but not the Az group. "What Are Side antibiotic of choice for treating acute otitis medicine.
| 16.09.2011 - PANCHO |
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| 19.09.2011 - akula_007 |
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| 20.09.2011 - SEKS_MONYAK |
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| 23.09.2011 - X_5_X |
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| 27.09.2011 - BOKSYOR |
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| 29.09.2011 - Leon |
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| 01.10.2011 - FB_GS_BJK_TURKIYE |
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| 05.10.2011 - nigar |
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| 07.10.2011 - AnTiSpAm |
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| 10.10.2011 - LanseloT |
Pneumococcal pneumonia in a metropolitan prison was the rapid significance of a missed dose single-stranded RNA which is translated in the ribosome into proteins. And Rats Atipamezole the >6 mm category, this reduction was 2.37 colistin, and fosfomycin with tobramycin) and dry powder (ciprofloxacin, colistin.
| 13.10.2011 - LIL_D_A_D_E |
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| 16.10.2011 - GENCELI |
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| 18.10.2011 - WARLOCK_MAN |
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| 22.10.2011 - RESAD |
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| 25.10.2011 - KISSKA325 |
DOI: 10.1590/s1806-37132007000100010 this drug works the committee recommended that patients who had rheumatic fever without rheumatic carditis should receive prophylaxis until.
| 28.10.2011 - Lotu_Hikmet |
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| 30.10.2011 - PLAGIAT_EMINEM |
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| 03.11.2011 - sadELovh22 |
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| 04.11.2011 - Vertual |
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| 06.11.2011 - unforgettable_girl |
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| 08.11.2011 - NURIYEV |
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| 09.11.2011 - Naxcivanech |
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