Use of antibiotics in periodontal treatment
PD Dr. Kristina Bertl, PhD MSc MBA
In light of the growing problem of antimicrobial resistance, any use of antibiotics in dentistry should be given careful consideration, and antibiotics should only be administered if they can genuinely lead to a clinically significant improvement in treatment outcome. It is therefore important to develop guidelines on this topic that are based on the available literature, and just such a guideline was recently drawn up by the German Society of Periodontology (DG Paro): ‘Use of systemic antibiotics as an adjuvant to subgingival instrumentation as part of systematic periodontal treatment’
When should antibiotics be prescribed as an adjunctive therapy to non-surgical periodontal treatment? The guideline, which is still based on the old classification scheme for periodontal diseases, distinguished between patients with chronic and aggressive periodontitis. By using the below-cited age references, however, these guidelines can also be directly harmonized with the new classification:
- Systemic antibiotics can be prescribed to chronic periodontitis patients who are younger than 56 years and whose pocket probing depths are ≥ 5 mm in more than 35% of all recorded measurement sites.
- Patients with chronic periodontitis who are older than 56 years should usually not be treated with antibiotics.
- Systemic antibiotics can be prescribed to patients with aggressive periodontitis (age ≤ 35 years).
- A separate recommendation cannot be made for patients who have diabetes mellitus or who regularly consume tobacco. For these patient groups, the above-mentioned recommendations should be used.
In general, a systemically effective antibiotic should only be prescribed in direct connection with the mechanical removal of persistent supra- and, in particular, subgingival bacterial biofilms. This means that antibiotics should be prescribed directly after treatment, and the patient should be instructed to take them immediately.
What antibiotic should be used, and at what dose?
The combination of amoxicillin and metronidazole is recommended as first choice, and metronidazole alone is recommended as second choice. The dosage of 500 mg amoxicillin and 400 mg metronidazole should be taken 3 times per day for 7 days.
(The wording of the recommendations has been taken from the guideline.)
- Administration of systemic antibiotics during non-surgical periodontal therapy-a consensus report. Pretzl B, Sälzer S, Ehmke B, Schlagenhauf U, Dannewitz B, Dommisch H, Eickholz P, Jockel-Schneider Y. Clin Oral Investig. 2018 Oct 29. doi: 10.1007/s00784-018-2727-0.