OPTION 2

Subantimicrobial-Dose Doxycycline

 

•            20-mg dose of doxycycline hyclate (Periostat)- approved and indicated as an adjunct to SRP in the treatment of chronic periodontitis.

•            Taken twice daily for 3 months, up to a maximum of 9 months of continuous dosing.

•            The 20-mg dose exerts its therapeutic effect by enzyme, cytokine and osteoclast inhibition rather than by any antibiotic effect.

•            At present, SDD is the only HMT specifically indicated for the treatment of chronic periodontitis that is approved by the (FDA) and (ADA).

 

 

 

MECHANISM OF ACTION OF SDD

 

 

•            Inhibition of production of epithelial-derived MMPs by inhibiting cellular expression synthesis

 

•            Direct inhibition of active MMPs by cation chelation (dependent on Ca2+ and Zn2+ binding properties)

•            Inhibition of oxidative activation of latent MMPs (independent of cation-binding properties)

•            Downregulates expression of key inflammatory cytokines including IL-1, IL-6, and TNF-α as well as PGE2

•            Scavenges and inhibits production of reactive oxygen species (ROS) produced by PMNs (e.g., HOCI, which activates latent MMPs)

•            Inhibition of MMPs and ROS protects α1 proteinase inhibitor (1-PI), thereby indirectly reducing

tissue proteinase activity.

•            Stimulates fibroblast collagen production

 

 

 

Key concept:

Subantimicrobial Dose Doxycycline (SDD) Doxycycline Hyclate (Periostat):-

•            Dosage – 20-mg capsule, twice daily for 3 to 9 months of continuous dosing.

•            Inhibition of enzyme, cytokine, and osteoclast

•            It acts by suppression of the activity of collagen, particularly that produced by

PNM’s.

•            At present, SDD (Periostat) is the only systemically administered HMT specifically indicated for the treatment of chronic periodontitis that is approved