Designing a novel chitosan-based periofilm containing metronidazole–ciprofloxacin

The Effectiveness of Metronidazole as a Localized Drug Delivery System in the Treatment of Periodontal Diseases: A Narrative Review

Periodontitis is a complex, multifactorial chronic inflammatory condition that impacts the adjacent hard and soft tissues. Microorganisms, especially gram-negative anaerobic pathogens, are a causative factor for periodontal disease. Periodontitis is identified by observing deeper periodontal pockets, clinical attachment loss, and the reduction of alveolar bone, often in conjunction with these indicators. The condition can vary in severity and be classified as mild, moderate, or severe. Scaling and root planing, combined with mechanical debridement, may not adequately reduce the bacterial load; therefore, adding local or systemic antimicrobials is advised as an adjunctive treatment. Commonly utilized local drug delivery agents for patients suffering from periodontitis include tetracycline, metronidazole, minocycline, doxycycline, and chlorhexidine. This system targets the pockets and eliminates the pathogens. Metronidazole is a nitroimidazole compound used commonly against gram-negative anaerobes. Its mechanism lies in four basic steps through which bacterial cell death occurs. A 25% metronidazole gel is used widely in periodontitis patients. The effectiveness of metronidazole as a local drug delivery agent has been evaluated in numerous studies, which have shown improvements in clinical parameters. To achieve favorable clinical outcomes, the non-surgical treatment of peri-implantitis should involve the systemic or local administration of metronidazole. Thus, the role of metronidazole in the emergence of periodontal diseases and its therapeutic uses are investigated in this narrative review.

Metronidazole Modified-Release Therapy Using Two Different Polymeric Systems Gels or Films: Clinical Study for the Treatment of Periodontitis

This study evaluated the efficacy of semisolid systems (gels) and films containing a combination of metronidazole (MTZ) and metronidazole benzoate after scaling and root-planing (SRP) for periodontitis. In total, 45 patients with stage I or II periodontitis were enrolled and divided into 3 groups: 1-SRP-control; 2-SRP + Film with MTZ; 3-SRP + Gel with MTZ. The pH of gingival crevicular fluid (GCF) before/after treatments, MTZ concentrations, and drug release using high-performance liquid chromatography were investigated. The effects were evaluated by longitudinal monitoring of clinical parameters (probing depth-PD, clinical attachment level-CAL, and bleeding on probing-BP). MTZ and MTZ-benzoate concentrations in the periodontal pocket and pH showed no statistical difference after application. SRP + Gel presented the lowest CAL values. For SRP + Film and SRP + Gel, higher PD values were observed at T0 compared to all groups. A relevant reduction in BP was observed in SRP + Film and SRP + Gel groups at all times compared to T0. Both therapies improved periodontal health compared to SRP alone, reducing PD and BP, and increasing CAL for the gel group, suggesting they are promising for periodontal disease treatment.

Recent advancements and perspective of ciprofloxacin-based antimicrobial polymers

In recent years, microbial pathogens, which are major sources of infections, have become a widespread concern across the world. The number of deaths caused by infectious diseases is continually rising, according to World Health Organization records. Antimicrobial resistance, particularly resistance to several drugs, is steadily growing in percentages of organisms. Ciprofloxacin is a second-generation fluoroquinolone with significant antimicrobial activity and pharmacokinetic characteristics. According to studies, many bacteria are resistant to the antibiotic ciprofloxacin. In this article, we look into polymers as ciprofloxacin macromolecular carriers with a wide range of antibacterial activity. We also discuss the latter form of coupling, in which ciprofloxacin and polymers are covalently bonded. This article also discusses the use of antimicrobial polymers in combination with ciprofloxacin in a various sectors. The current review article provides an overview of publications in the last five years on polymer loaded or modified with ciprofloxacin having applications in numerous sectors.