Pharmacology · patient case question
What is the treatment?
Patient case: ANUG — blunted papillae and fetid odour
Scenario: A clinical photograph of ANUG showing BLUNTED PAPILLAE and FETID ODOUR.
Show answer and explanation
Correct answer: C. Metronidazole
- A. Tetracycline has broad activity and is used in some periodontal contexts, but it is not the anaerobe-specific agent of choice for ANUG.
- B. Clindamycin does cover anaerobes and is an alternative, but metronidazole is the standard first-line choice for ANUG.
- C. Correct. METRONIDAZOLE is the antibiotic of choice because it is specifically active against obligate ANAEROBES — precisely the fusospirochetal flora driving necrotizing periodontal disease. It is used alongside gentle debridement, hydrogen peroxide or chlorhexidine rinses, analgesia, and correction of predisposing factors.
- D. Amoxicillin alone has inadequate anaerobic coverage; amoxicillin COMBINED with metronidazole is used in aggressive periodontal disease.
Note: Do not overlook the non-pharmacologic side: ANUG is driven by STRESS, SMOKING, immunosuppression, malnutrition and poor oral hygiene. Persistent or unusually severe necrotizing disease should prompt consideration of HIV testing. Warn patients on metronidazole to avoid ALCOHOL (disulfiram-like reaction).