Dear Dr Nath,

Would you please clarify your question? What do you mean by 'strains of AAC'?

Martin Levine

I could not understand CGP and GAP either.

generalized aggressive periodontitis (GAP), chronic generalized periodontitis (CGP). Go to http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3357029/

Hello Dr. Nath,

Even though similar bacteria are present in chronic and aggressive periodontitis, the bacteria profiles appear to be slightly different. P.gingivalis, T. forsythia, and T.denticola are generally thought of as the significantly contributing bacteria of Chronic periodontitis, and A.actinomycetemcomitans as the bacteria of Aggressive periodontitis.

Now to answer your question regarding Cipro. The significant bacteria of Chronic periodontitis are strict anaerobes and Gram negative. Cipro is good against Gram negative bacteria, but has poor activity against anaerobes compared to Metronidazole or Amoxicillin, therefore, Ciprofloxacin is a poor choice of antibiotic to use in treatment of Chronic periodontitis. For Aggressive periodontitis, A.actinomycetemcomitans is a Gram negative facultative anaerobe. Again, the limitation of using Cipro, compared to Amoxicillin and Metronidazole, is the poor effect of Cipro against an anaerobic pathogen (in this case a facultative anaerobe). Now the benefit of using Amoxicillin and Metronidazole in combination for Aggressive periodontitis is that Amoxicillin covers both Gram positive and Gram negative pathogens (there are some suspected Gram positive periodontal pathogens), and the Metronidazole provides significant anaerobic coverage. I hope that answers your question. Tom

Then why not Ciprofloxacin + metronidazole instead of amox+metro

Hello Amit,

Ciprofloxacin + metronidazole can be used as an alternative in patients allergic to amoxicillin. The Journal of Periodontology 2004 AAP Position Paper - Systemic Antibiotics in Periodontics* is a good review of the topic.

Tom