Adjunctive therapies in non-surgical periodontal treatment III
Following Part I (local and systemic non-antibiotic adjunctive therapies) and Part II (local antibiotics and antiseptics) about adjunctive therapies in non-surgical periodontal treatment, Part III now goes on to look at the results from the Perio Workshop 2019 regarding the effects of using systemic antibiotics as part of non-surgical periodontal treatment.
As part of the Perio Workshop 2019, a review led by Wim Teughels (University in Leuven, Belgium) and Magda Feres (Guarulhos University in São Paulo, Brazil) pooled the available randomized clinical studies about the use of systemic antibiotics in periodontitis patients as an adjunct to non-surgical periodontal treatment compared with taking a placebo. The selected studies had a follow-up of least 6 months.
In total, 28 studies in 34 publications were identified, and the following antibiotics were investigated:
- Combination of metronidazole & amoxicillin (17 studies)
- Azithromycin (7 studies)
- Metronidazole (4 studies)
- Clarithromycin (2 studies)
- Spiramycin (2 studies)
- Ornidazole (1 study)
- Tetracycline (1 study)
- Minocycline (1 study)
- Moxifloxacin (1 study)
- Amoxicillin (1 study)
Of these 28 studies, 24 could be statistically analyzed, and the authors came to the following conclusions:
- In particular, compared with taking a placebo, taking the combination of metronidazole and amoxicillin leads to a statistically significantly higher reduction in probing pocket depth (approx. 0.5 mm), a larger number of ‘closed’ probing pocket depths after treatment (number of probing pocket depths ≤ 3 mm), a significant reduction in the number of probing pocket depths of ≥ 4 mm, ≥ 5 mm, ≥ 6 mm and ≥ 7 mm, a greater improvement in clinical attachment level (approx. 0.4 mm) and a reduction in bleeding on probing.
- The additional reduction in probing pocket depth was even more pronounced for deep baseline probing pocket depths, with an additional reduction in probing pocket depth of approximately 1.2 mm for the combination of metronidazole and amoxicillin.
- These benefits remained stable up to 12 months. Unfortunately, however, very few studies with follow-up periods longer than this are available, meaning that it is not possible to comment on the long-term effect.
- Although the combination of metronidazole and amoxicillin was classified as the most effective approach clinically speaking, it also seemed to be associated with a comparatively higher incidence of side effects.
- After the combination of metronidazole and amoxicillin, monotherapy with metronidazole or azithromycin was found to be the second most promising approach. Even if the administration of antibiotics seems to lead to a greater reduction in probing pocket depths, their use must always be weighed up against the risk of furthering antibiotic resistance, and patients should be selected for this treatment according to the severity of their disease.
You can find another article on this topic in the Prophy Community:
- Wim Teughels, Magda Feres, Valerie Oud, Conchita Martín, Paula Matesanz, David Herrera. Adjunctive Effect of Systemic Antimicrobials in Periodontitis Therapy. A Systematic Review and Meta-Analysis. J Clin Periodontol. 2020. doi: 10.1111/jcpe.13264.