Evaluation of Subgingival Bacteria in the Dog and
Susceptibility to Commonly Used Antibiotics

Mirko Radice, DVM; Piera Anna Martino, DBSc, PhD; Alexander M Reiter, Dipl Tzt, Dr med vet progression from a healthy periodontium to gingivitis andperiodontitis, there is a shift from a gram-positive oriented, aerobic facultative flora to a predominantly gram-negative, The aim of the present investigation was to evaluate the anaerobic flora.22 Periodontopathogens are bacteria that cause subgingival aerobic and anaerobic flora of 13 dogs with gingivitis and periodontitis. A catalase-positive form of the gram periodontal disease and the susceptibility of these bacteria negative Porphyromonas gingivalis is considered to be the key to antibiotics currently approved in Italy for treatment of periodontopathogen in cats and dogs15,23-25 and is recognized as P. canine infections. Of the anaerobic bacteria, Bacteroides gulae.26 Other canine and feline Porphyromonas organisms fragilis was most frequently isolated, followed by include P. assacharolytica, P. cangingivalis, P. canoris, P. cansulci, Peptostreptococcus + Porphyromonas gingivalis and P. endodontalis, P. circumdentaria, P. crevioricanis, P. salivosa, P. Prevotella intermedia. Of the aerobic bacteria, α-hemolytic denticanis, and P. gingivicanis.11,27-30 Additional black-pigmented Streptococcus was most frequently isolated, often associated anaerobic bacteria associated with periodontal disease include with Escherichia coli or Pasteurella multocida. Resistance Prevotella intermedia23 and Bacteroides spp.17,18,31,32 Pathogen- of anaerobic and aerobic bacteria to various antibiotics was related oral spirochetes also are considered to play an important generally high. Anaerobic bacteria appeared to be role in periodontal disease, but cultivation studies in cats and dogs susceptible to amoxicillin + clavulanic acid, doxycycline, have only been reported sparsely.8,32-35 and erythromycin; aerobic bacteria appeared to be Previous studies showed that amoxicillin + clavulanic acid susceptible to amoxicillin + clavulanic acid, erythromycin, and clindamycin had high in vitro susceptibility against anaerobes gentamycin, and sulfa-trimethoprim. Bacteroides fragilis and enrofloxacin high in vitro susceptibility against aerobes from was resistant to all of the antibiotics tested. The emerging subgingival plaque samples in cats and dogs.36,37 Although worldwide problem of bacterial resistance to antibiotics periodontal disease is caused by bacteria, antibiotic therapy should resulting from overuse and misuse of antibiotics is not be the primary treatment strategy.38,39 Unfortunately, there is a discussed. J Vet Dent 23 (4); #$% - &*, 2006
tendency among veterinarians to use antibiotics as part of themanagement of any animal with periodontal disease or other oralcondition. Resistance of plaque bacteria to antibiotics has clearly been demonstrated in humans,40-43 and a similar pattern of bacterial Periodontal disease is an infectious condition of the tooth resistance development may be present in cats and dogs.
supporting tissues (gingiva, periodontal ligament, alveolar bone, The aim of the present investigation was to evaluate the and cementum) and is considered to be the most common disease subgingival flora (aerobic and anaerobic bacteria) of dogs with in companion animals. The accumulation of plaque on tooth periodontal disease and the susceptibility of these bacteria to surfaces is responsible for the development of gingivitis and antibiotics currently approved in Italy for treatment of canine infections. Furthermore, the emerging problem of bacterial Gingivitis is inflammation of the gingiva and is reversible, if resistance to antibiotics in human and veterinary medicine is plaque is removed by home or professional oral hygiene procedures.2 In addition to toxins and tissue-destructive enzymesproduced by periodontopathogenic bacteria, the host's response to Materials and Methods
plaque leads to the release of agents from damaged neutrophils Thirteen client-owned dogs with various degrees of that can cause injury to the body's own tissues.1 Inflammation periodontal disease (ranging from gingivitis to periodontitis as may spread along the periodontal space and ultimately progresses assessed by means of periodontal probing) were included in this to periodontitis, which is diagnosed as loss of attachment study. There were three Yorkshire terriers, one German shepherd, (gingival recession, resorption of alveolar bone, and formation of one poodle, and eight mixed-breed dogs. Two dogs received periodontal pockets). The periapical region of the tooth root may sporadic oral hygiene at home. A professional scaling and become affected, leading to retrograde pulpal infection. Thus, polishing had been performed on all dogs 6-months prior to endodontic disease can occur as a result of severe periodontal sample collection. Antibiotics had been given to most of the dogs disease. Eventually the tooth becomes mobile and is lost due to in the past for conditions other than periodontal disease. However, spontaneous exfoliation or professional extraction.1 no attempt was made to assess details of antibiotic history Gingivitis and periodontitis are referred to as ‘bacterial because owners were not able to verify names of antibiotics used, infections', but several hundred bacterial species have been dates and routes of administration, duration of therapies, etc.
identified to date in normal and diseased mouths of cats and Dogs had not received antibiotic therapy for at least 2-weeks dogs.3-21 With maturation of plaque in subgingival areas and before bacterial sampling. ??? J.VET.DENT. Vol. 23 No. 4 December 2006 219

Sample collection was performed under general anesthesia at the detachment of microbial cells. Two dilutions (Log10) were the right maxillary canine tooth (104) and the right maxillary made for all samples that were plated on Tryptic Soy Agar plates fourth premolar tooth (108) since both teeth had been excluded with 5 % sheep bloodb for aerobic bacteria and on Brucella Agarc from prior periodontal probing. A sterile endodontic paper point for anaerobic bacteria. The plates were incubated aerobically for was inserted into the depth of the gingival sulcus or periodontal 24 to 48-hours at 37°C, and anaerobicallyd for 48 to 72-hours at pocket at buccal aspects of the teeth. The paper point was removed after a few seconds and placed into tubes containing a The anaerobic flora was identified by growth on Brucella transport liquid media (thioglycollate broth)a for growth of Agare, a medium containing Vit K and haemin. Gram's staining, aerobic and anaerobic bacteria. The samples were immediately Schaffer & Fulton's staining for spores, and API System 20Af transported to the reference laboratory and were vortexed to allow were used as biochemical reference methods.
Aerobic bacteria were identified by their macroscopic (e.g., morphology of colonies, presence of hemolysis) and microscopic (using Gram-staining) characteristics; moreover, biochemical Signalment of the 13 dogs enrolled in the study.
tests were performed using macro- or micromethodsg. For theidentification of Streptococcus strains, the presence of hemolysis (α partial or β total) and the growth on Mitis Salivarius Agarh, a medium for the isolation and identification of the streptococci of the oral cavity, were evaluated. For identification of Pasteurella multocida, the lack of growth on Mac Conkey Agari was Evaluation of microbial sensitivity/resistance to antibiotics was performed using the Kirby-Bauer reference method or the agar disk diffusion test. A bacterial suspension, performed in saline buffer (0.9 % NaCl), was delivered onto a Mueller-Hinton plate, and then the disks containing different antibiotic moleculeswere placed on the plate. After incubation at 37°C under aerobic or anaerobic atmosphere for 24 to 48-hours, the susceptibility of each microorganism was recorded to the following antibiotics:amikacin, amoxicillin + clavulanic acid, doxycycline,erythromycin, gentamycin, kanamycin, metronidazole (only foranaerobes), and sulfa-trimethoprim.k Isolation of anaerobic bacteria.
Results of variables of signalment (sex, age, weight, and diet) Anaerobic bacteria of the 13 dogs enrolled in the study are reported in Table 1. The Peptostreptococcus + Porphyromonas majority of dogs were male (84.6 %), 5 to 10-years of age (53.8 %), < 12.0 kg (61.5 %), and eating a mixed (soft and dry) diet Bacteroides fragilis Prevotella intermedia Of the anaerobic bacteria (Table 2), Bacteroides fragilis was most frequently isolated from subgingival samples, followed byPeptostreptococcus + Porphyromonas gingivalis, and Prevotella Anaerobic bacteria intermedia. Of the aerobic bacteria (Table 3), α-haemolyticStreptococcus was most frequently isolated, often associated with Peptostreptococcus + Escherichia coli or Pasteurella multocida.
Porphyromonas gingivalis Susceptibility of anaerobic and aerobic bacteria to various antibiotics is shown in Tables 4-8. Resistance of isolated bacteriato tested antibiotics was generally high. Anaerobic bacteriaappeared to be susceptible to amoxicillin + clavulanic acid,doxycycline, and erythromycin, while aerobic bacteria appearedto be susceptible to amoxicillin + clavulanic acid, erythromycin, gentamycin, and sulfa-trimethoprim. Bacteroides fragilis was resistant to all of the antibiotics tested.
The aim of the present investigation was to evaluate the subgingival aerobic and anaerobic bacterial flora of 13 dogs with J.VET.DENT. Vol. 23 No. 4 December 2006

periodontal disease and the susceptibility of these bacteria to veterinarians, and diagnostic uncertainty. Several recent studies antibiotics currently approved in Italy for treatment of canine showed that pediatricians prescribe antibiotics significantly more infections. Except for the high prevalence of Bacteroides fragilis, often, if they perceive parents expect them, and significantly less the predominant subgingival flora obtained in this study confirms often, if they feel parents do not expect them.55-58 The best way to results reported in previous studies.15,17,18,23-25,31,32 Of the anaerobic combat this situation is to educate patients/patient owners and bacteria, Bacteroides fragilis was most frequently isolated, doctors/veterinarians to decrease both demand and over- followed by Peptostreptococcus + Porphyromonas gingivalis and prescribing. Unfortunately, there is a tendency to use antibiotics as Prevotella intermedia. The reason for the unusually high part of the management of any animal with periodontal disease or prevalence of Bacteroides fragilis is not clear. Differing results other oral condition, although there is no apparent justification for between isolation studies may be due to differences in study this practice. Similar to dogs in the present study, resistance of methodology, including sample population utilized and isolation plaque bacteria to antibiotics has clearly been demonstrated in techniques applied. Of the aerobic bacteria, α-haemolyticStreptococcus was most frequently isolated, often associated with Escherichia coli or Pasteurella multocida. The fast growth rate, high concentration of cells, genetic Isolation of aerobic bacteria.
processes of mutation and selection, and ability to exchange genesaccount for the extraordinary adaptation and evolution of bacteria.44 For these reasons bacterial resistance to antibiotics may α-hemolytic Streptococcus + E. coli take place very rapidly in evolutionary time. Risk factors α-hemolytic Streptococcus + P. multocida responsible for the emergence and spread of resistant bacteria α-hemolytic Streptococcus + E. coli include: (1) antibiotic use; (2) reservoirs for resistance; (3) α-hemolytic Streptococcus + E. coli medical advances; and (4) societal changes.45 Antibiotics make conditions favorable for overgrowth of some bacteria, including α-hemolytic Streptococcus S. intermedius + P. multocida those that possess mechanisms of drug resistance. If a resistant organism is present, antibiotics will create ‘selective pressure'favoring the growth of that organism. A number of studies havedemonstrated conclusively that the development of bacterial α-hemolytic Streptococcus resistance to antibiotics is correlated with the level of antibiotic + E. coli + P. multocida use.46-48 Antibiotic resistance of nosocomial pathogens in hospitals, α-hemolytic Streptococcus + E. coli + S. intermedius nursing homes, day-care centers, and animal facilities is increasedby the transfer of individuals already colonized by resistant + S. intermedius organisms from one location to another. Progress in the treatment of many diseases has led to an increased life span of humans andanimals. Consequently, with advanced age, chronic disease orimmunosuppression, individuals can be more susceptible tobacterial infections, resulting in greater use of antibiotics.
Worldwide spread of bacterial resistance to antibiotics hasoccurred due to the increased mobility of today's society.45 Pet animal numbers have substantially increased in modern α-hemolytic Streptococcus + P. multocida society, and attention is increasingly devoted to pet welfare.
Antibiotics are frequently used in small animal practice, withheavy use of broad-spectrum agents such as amoxicillin +clavulanic acid, cephalosporins, and fluoroquinolones. The practice of antibiotic overuse and misuse in cats and dogs hascontributed to the development of Staphylococcus spp., Antibiotic activity versus Prevotella intermedia.
Escherichia coli and various other bacteria that are resistant toantibiotics.49-53 The role of pets in the dissemination of bacterial resistance to antibiotics has been given relatively little attention when compared with that of food animals, and a marked contrast is evident between the current policies on antibiotic usage in companion and food animals. However, the possible transfer of resistant bacteria from cats and dogs to humans has recently been acknowledged as a potential threat to public health.44,54 One of the biggest problems is inappropriate prescribing of antibiotics. There are many reasons for this, including demand from patients/patient owners, time pressure on physicians/ J.VET.DENT. Vol. 23 No. 4 December 2006 221
Antibiotic activity versus Bacteroides fragilis.
Antibiotic activity versus Porphyromonas gingivalis +Peptostreptococcus.
Antibiotic activity versus α-haemolytic Streptococcus + E.
Antibiotic activity versus α-haemolytic Streptococcus + P.
humans.40-43 It is therefore imperative to review periodontaltreatment strategies and determine whether systemic antibiotics have a role to play in the management of periodontal disease.
If accumulation of plaque is prevented, periodontal disease American Veterinary Dental College (AVDC) Position does not develop.2 Although this condition is caused by bacteria, Statement on the Use of Antibiotics in Veterinary Dentistry.
antibiotic therapy is not considered the primary treatmentstrategy.38,39 Instead, treatment of periodontal disease should be The AVDC endorses the use of systemic antibiotics in directed at mechanical removal or reduction of plaque and veterinary dentistry for treatment of some infectious calculus accumulation, suppression of the tissue-destructive conditions of the oral cavity. Although culture andsusceptibility testing is rarely performed on individual effects of the inflammatory response, surgical management of patients that have an infection extending from/to the oral periodontal pockets, extraction of more severely affected teeth, cavity, the selection of an appropriate antibiotic should be and thorough debridement of extraction sites.1 A controlled- based on published data regarding susceptibility testing release local antibiotic delivery system, reaching of the spectra of known oral pathogens. Patients that are periodontopathogens deep within periodontal pockets, has been scheduled for an oral procedure may benefit from pre-treatment with an appropriate antibiotic to improve the described in dogs.59 Professional supra- and subgingival scaling, health of infected oral tissues. Bacteremia is a recognized followed by daily tooth brushing, is the ‘gold standard' for sequela to dental scaling and other oral procedures.
prevention of periodontal disease.1 Home oral hygiene may be Healthy animals are able to overcome this bacteremia enhanced by offering products that support dietary abrasion or without the use of systemic antibiotics. However, use of asystemically administered antibiotic is recommended to chemically suppress plaque and calculus accumulation.60 reduce bacteremia for animals that are immune Bacteremia secondary to periodontal disease occurs daily in compromised, have underlying systemic disease (such patients with periodontal disease, and it is normally rapidly as clinically-evident cardiac, hepatic, and renal diseases) cleared by the reticulo-endothelial system in the healthy patient.61 and/or when severe oral infection is present. Antibiotics Therefore, for the great majority of otherwise healthy cats and should never be considered a monotherapy for treatmentof oral infections, and should not be used as preventive dogs presenting with periodontal disease and other oral management of oral conditions. Adopted by the Board of conditions, systemic antibiotics are not indicated.1,39 Bacteremia Directors, April 2005 can be prevented or reduced in severity by rinsing the oral cavity J.VET.DENT. Vol. 23 No. 4 December 2006 with dilute chlorhexidine gluconate (0.12 %) prior to di cani con parodontopatie e loro antibiotico-sensibilità. Tesi di laurea, Relatore Dott.ssa P.A. Martino, 2003. Facoltà di Medicina Veterinaria, Milano.
commencing the oral procedure. Perioperative systemicantibiotics are indicated in: (1) debilitated and 4. Courant PR, Saxe SR, Nash L, Roddy S. Sulcular bacteria in the beagle dog. Periodontics 1968; 6: 250-252.
immunocompromised patients; (2) patients suffering from organ Harvey CE, Thornsberry C, et al. Subgingival bacteria--comparison of culture results in disease, endocrine disorders, cardiovascular disease, and severe dogs and cats with gingivitis. J Vet Dent 1995; 12:147-150.
local and/or systemic infections; and (3) patients having Hennet PR, Harvey CE. Aerobes in periodontal disease in the dog: a review. J Vet Dent permanent implants and transplants. Unless there is a well- 1991; 8: 9-11.
founded positive reason for their administration, systemic Hennet PR, Harvey CE. Anaerobes in periodontal disease in the dog: A Review. J Vet antibiotics should not be used.
Dent 1991; 8: 18-21.
Although there is a position statement on the use of Hennet PR, Harvey CE. Spirochetes in periodontal disease in the dog: a review. J Vet Dent 1991; 8: 16-17.
antibiotics in veterinary dentistry provided by the American Isogai E, Isogai H, et al. Oral flora of mongrel and beagle dogs with periodontal disease. Veterinary Dental College (Table 9),62 compulsory guidelines for Nippon Juigaku Zasshi 1989; 51: 110-118.
prudent prescription patterns and use of antibiotics in small 10. Isogai H, Isogai E, et al. Detection of serum antibodies of oral Porphyromonas animals with periodontal disease or other oral conditions, which (Bacteroides) asaccharolyticus in dogs: relationship to periodontal disease. Nippon Juigaku Zasshi 1989; 51: 1239-1241.
describe the minimum requirements to be followed byveterinarians, are not available. Key elements of these guidelines 11. Isogai HY, Kosako Y, et al. Ecology of genus Porphyromonas in canine periodontal disease. J Vet Med B 1999; 46:467-473.
should be the use of antibiotics on the basis of an exact 12. Leonhardt A, Berglundh T, et al. Putative periodontal pathogens on titanium implants and (preferentially microbiological) diagnosis, choice of the most teeth in experimental gingivitis and periodontitis in beagle dogs. Clin Oral Implants Res suitable antibiotic (antibacterial spectrum as narrow as possible, 1992; 3: 112-119.
margin of safety as high as possible, and good tissue penetration 13. Newman MG, Sandler M, et al. The effect of dietary Gantrisin supplements on the flora of periodontal pockets in four beagle dogs. J Periodontal Res 1977; 12: 129-134.
if necessary), restricted use of antibiotics with last resortcharacter, and adherence to label instructions (no underdosing or 14. Nieves MA, Hartwig P, et al. Bacterial isolates from plaque and from blood during and after routine dental procedures in dogs. Vet Surg 1997; 26: 26-32.
prolongation of dosing interval, so-called "pulse dosing"). Any 15. Sarkiala EM, Asikainen SE, et al. The efficacy of tinidazole in naturally occurring deviation from the guideline recommendations must be justified periodontitis in dogs: bacteriological and clinical results. Vet Microbiol 1993; 36: 273- and recorded.63,64 16. Svanberg GK, Syed SA, et al. Differences between gingivitis and periodontitis associated microbial flora in the beagle dog. Relationship of plaque parameters to histological parameters of periodontal disease. J Periodontal Res 1982; 17: 1-11.
Thioglycollate Broth, Oxoid Ltd, Basingstoke, UK 17. Syed SA. Characteristics of Bacteroides asaccharolyticus from dental plaques of beagle Trypric Soy Agar plus 5 % Sheep Blood Plate, Oxoid Ltd, Basingstoke, UK dogs. J Clin Microbiol 1980; 11: 522-526.
Brucella Agar, Oxoid Ltd, Basingstoke, UK 18. Syed SA, Svanberg M, et al. The predominant cultivable dental plaque flora of beagle Gas Pak System, Becton Dickinson, Franklin Lakes, USA dogs with gingivitis. J Periodontal Res 1980; 15: 123-136.
Brucella Agar, Oxoid Ltd, Basingstoke, UK 19. Syed SA, Svanberg M, et al. The predominant cultivable dental plaque flora of beagle dogs with periodontitis. J Clin Periodontol 1981; 8: 45-56.
API 20A System, BioMériéux, Lion, France API 20E and API 20NE Systems, BioMériéux, Lion, France 20. Takada K, Hirasawa M. Expression of trypsin-like activity by the genera Corynebacterium and Actinomyces in canine periodontitis. J Med Microbiol 2000; Mitis Salivarius Agar, DIFCO, DID, Detroit, USA 49: 621-625.
Mac Conkey Agar n°3, Oxoid Ltd, Basingstoke, UK 21. Wunder JA, Briner WW, et al. Identification of the cultivable bacteria in dental plaque Mueller-Hinton Agar, Oxoid Ltd, Basingstoke, UK from the beagle dog. J Dent Res 1976; 55: 1097-1102.
All disks used for antimicrobial sensitivity tests produced by Oxoid Ltd, 22. Williams RC, Leone CW, et al. Tetracycline treatment of periodontal disease in the beagle dog. II. The cultivable periodontal pocket flora. J Periodontal Res 1981; 16:666-674.
23. Allaker RP, Rosayro R, et al. Prevalence of Porphyromonas and Prevotella species in the dental plaque of dogs. Vet Rec 1997; 140: 147-148.
24. Saito A, Hosaka Y, et al. Responses of peri-implant tissues to undisturbed plaque From Via A. Volta 7 (Radice), 20030 Palazzolo, Milano, formation in dogs: clinical, radiographic, and microbiological findings. Bull Tokyo Dent Italy; the Department of Veterinary Pathology, Hygiene and Coll 1997; 38:13-20.
Public Health (Martino), Section of Microbiology and 25. Yamasaki T, Nagata A, et al. Black-pigmented, asaccharolytic Bacteroides species resembling Porphyromonas gingivalis (Bacteroides gingivalis) from beagle dogs. Oral Immunology, Faculty of Veterinary Medicine - University of Microbiol Immunol 1990; 5:332-335.
Milan, Via Celoria, 10 – 20133 Milano. Italy; and the Matthew J.
26. Fournier D, Mouton C, et al. Porphyromonas gulae sp. nov., an anaerobic, gram- Ryan Veterinary Hospital of the University of Pennsylvania negative coccobacillus from the gingival sulcus of various animal hosts. Int J Syst Evol Microbiol 2001; 51:1179-1189.
(Reiter), 3900 Delancey StreetPhiladelphia, PA 19104Corresponding author Email: 27. Allaker RP, Young KA, et al. Dental plaque flora of the dog with reference to fastidious and anaerobic bacteria associated with bites. J Vet Dent 1997; 14: 127-130.
28. Boyce EN, Ching RJ, et al. Occurrence of gram-negative black-pigmented anaerobes in subgingival plaque during the development of canine periodontal disease. Clin Infect Dis 1995; 20(Suppl 2):S317-319.
1. Harvey CE. Management of periodontal disease: understanding the options. Vet Clin North Am Small Anim Pract 2005; 35:819-836.
29. Collins MD, Love DN, et al. Phylogenetic analysis of members of the genus Porphyromonas and description of Porphyromonas cangingivalis sp. nov. and Lindhe J, Hamp S-E, et al. Plaque induced periodontal disease in beagle dogs. A 4-year Porphyromonas cansulci sp. nov. Int J Syst Bacteriol 1994; 44:674-679.
clinical, roentgenographical and histometrical study. J Periodontal Res 1975;10:243-255.
30. Hardham J, Dreier K, et al. Pigmented-anaerobic bacteria associated with canine Assi S. Indagine preliminare sui batteri aerobi ed anaerobi associati alle tasche gengivali periodontitis. Vet Microbiol 2005; 106:119-128.
J.VET.DENT. Vol. 23 No. 4 December 2006 223
31. Chung CP, Nisengard R, et al. Bacterial antibody titers in ligature-induced periodontitis in 59. Hayashi K, Takada K, et al. Clinical and microbiological effects of controlled-release local beagle dogs. J Periodontol 1983; 54: 236-246.
delivery of minocycline on periodontitis in dogs. Am J Vet Res 1998; 59: 464-467.
32. Mikx FH, Ngassapa DN, et al. Effect of splint placement on black-pigmented Bacteroides 60. Roudebush P, Logan E, et al. Evidence-based veterinary dentistry: a systematic review and spirochetes in the dental plaque of beagle dogs. J Dent Res 1984; 63: 1284-1288.
of homecare for prevention of periodontal disease in dogs and cats. J Vet Dent 2005; 22: 6-15.
33. Mikx FH, Maltha JC, et al. Spirochetes in early lesions of necrotizing ulcerative gingivitis experimentally induced in beagles. Oral Microbiol Immunol 1990; 5: 86-89.
61. Silver JG, Martin L, McBride BC. Recovery and clearance of oral microorganisms following experimental bacteremias in dogs. Arch Oral Biol 1975; 20: 675-679.
34. Riviere GR, Thompson AJ, et al. Detection of pathogen-related oral spirochetes, Treponema denticola, and Treponema socranskii in dental plaque from dogs. J Vet Dent 62. Website of the American Veterinary Dental College (AVDC): 1996; 13: 135-138.
35. Valdez M, Haines R, et al. Isolation of oral spirochetes from dogs and cats and provisional 63. Ungemach FR, Muller-Bahrdt D, et al. Guidelines for prudent use of antimicrobials and identification using polymerase chain reaction (PCR) analysis specific for human plaque their implications on antibiotic usage in veterinary medicine. Int J Med Microbiol 2006; Treponema spp. J Vet Dent 2000; 17: 23-26.
36. Harvey CE, Thornsberry C, et al. Antimicrobial susceptibility of subgingival bacterial flora in dogs with gingivitis. J Vet Dent 1995; 12: 151-155.
64. Weese JS. Investigation of antimicrobial use and the impact of antimicrobial use guidelines in a small animal veterinary teaching hospital: 1995-2004. J Am Vet Med 37. Harvey CE, Thornsberry C, et al. Antimicrobial susceptibility of subgingival bacterial flora Assoc 2006; 228: 553-558.
in cats with gingivitis. J Vet Dent 1995; 12: 157-160.
38. Preshaw PM. Antibiotics in the treatment of periodontitis. Dent Update 2004; 31: 448-456.
39. Sarkiala E, Harvey CE. Systemic antimicrobials in the treatment of periodontitis in dogs. Sem Vet Med Surg 1993; 8: 197-203.
40. Feres M, Haffajee AD, et al. Antibiotic resistance of subgingival species during and after antibiotic therapy. J Clin Periodontol 2002; 29: 724-735.
41. Handal T, Caugant DA, et al. Antibiotic resistance in bacteria isolated from subgingival plaque in a Norwegian population with refractory marginal periodontitis. Antimicr Agents Chemother 2003; 47: 1443-1446.
42. Ready D, Lancaster H, et al. Effect of amoxicillin use on oral microbiota in young children. Antimicr Agents Chemother 2004; 48: 2883-2887.
43. Winkelhoff AJ, Herrera D, et al. Antimicrobial profiles of periodontal pathogens isolated from periodontitis patients in the Netherlands and Spain. J Clin Periodontol 2005; 32: 893-898.
44. Guardabassi L, Schwarz S, et al. Pet animals as reservoirs of antimicrobial-resistant bacteria. J Antimicrob Chemother 2004; 54: 321-332.
45. Website of the Department of Health and Human Services, Centers for Disease Control and Prevention (CDC):
46. Cohen FL, Tartasky D. Microbial resistance to drug therapy: a review. Am J Infect Control 1997; 25: 51-64.
47. Hanberger H, Hoffmann M, et al. High incidence of antibiotic resistance among bacteria in four intensive care units at a university hospital in Sweden. Scand J Infect Dis 1997; 29: 607-614.
48. Muder RR, Brennen C, et al. Multiply antibiotic-resistant gram-negative bacilli in a long- term-care facility: a case control study of patient risk factors and prior antibiotic use. Infect Control Hosp Epidemiol 1997; 18: 809-813.
49. Cohn LA, Gary AT, et al. Trends in fluoroquinolone resistance of bacteria isolated from canine urinary tracts. J Vet Diagn Invest 2003; 15: 338-343.
50. Gortel K, Campbell KL, et al. Methicillin resistance among staphylococci isolated from dogs. Am J Vet Res 1999; 60: 1526-1530.
51. Lanz R, Kuhnert P, et al. Antimicrobial resistance and resistance gene determinants in clinical Escherichia coli from different animal species in Switzerland. Vet Microbiol 2003; 91: 73-84.
52. Rantala M, Lahti E, et al., Antimicrobial resistance in Staphylococcus spp., Escherichia coli and Enterococcus spp. in dogs given antibiotics for chronic dermatological disorders, compared with non-treated control dogs. Acta Vet Scand 2004; 45: 37-45.
53. Sanchez S, McCrackin Stevenson MA, et al. Characterization of multidrug-resistant Escherichia coli isolates associated with nosocomial infections in dogs. J Clin Microbiol 2002; 40: 3586-3595.
54. Malik S, Peng H. et al. Antibiotic resistance in staphylococci associated with cats and dogs. J Appl Microbiol 2005; 99: 1283-1293.
55. Christakis DA, Wright JA, et al. Association between parental satisfaction and antibiotic prescription for children with cough and cold symptoms. Pediatr Infect Dis J 2005; 24: 774-777.
56. Mangione-Smith R, McGlynn EA, et al. Parent expectations for antibiotics, physician- parent communication, and satisfaction. Arch Pediatr Adolesc Med 2001; 155: 800-806.
57. Mangione-Smith R, Stivers T, et al. Online commentary during the physical examination: a communication tool for avoiding inappropriate antibiotic prescribing? Soc Sci Med2003; 56:313-320.
58. Watson RL, Dowell SF, et al. Antimicrobial use for pediatric upper respiratory infections: reported practice, actual practice, and parent beliefs. Pediatrics 1999; 104: 1251-1257.
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Influence of antihypertensive therapy on cerebral perfusion in patients with metabolic syndrome: relationship with cognitive function and 24&#x2010;h arterial blood pressure monitoring

ORIGINAL RESEARCH ARTICLE Influence of Antihypertensive Therapy on Cerebral Perfusion inPatients with Metabolic Syndrome: Relationship with CognitiveFunction and 24-h Arterial Blood Pressure Monitoring Nataliya Y. Efimova,1,2 Vladimir I. Chernov,1,2 Irina Y. Efimova1 & Yuri B. Lishmanov1,2 1 Federal State Budgetary Scientific Institution, Research Institute for Cardiology, Tomsk, Russia2 National Research Tomsk Polytechnic University, Tomsk, Russia

HIGHLIGHTS OF PRESCRIBING INFORMATION Suicidal Behavior and Ideation (5.1) These highlights do not include all the information needed to use Patients should be advised that VIMPAT may cause dizziness VIMPAT® safely and effectively. See full prescribing information and ataxia. (5.2) for VIMPAT.