Amoxicillin and Metronidazole as an Adjunct to Full‐Mouth Scaling and Root Planing of Chronic Periodontitis

Abstract

Systemic metronidazole and amoxicillin significantly improved the 6-month clinical outcomes of full-mouth non-surgical periodontal debridement, thus significantly reducing the need for additional therapy.

Evaluation of the use of systemic antimicrobial agents by professionals for the treatment of periodontal diseases

“…In the present study, 20% of the professionals reported indicating the use of antibiotics in the treatment of chronic periodontitis, irrespective of the severity of the disease or the patient's smoking habit, aspects considered relevant when the use of antibiotic therapy is referred to in chronic periodontal disease therapy. In spite of these studies demonstrating positive results with the use of antibiotics as adjunct to the treatment of chronic periodontitis 2,3,8,18,28,30 , a recent systematic review showed that there is still insufficient and inconclusive evidence to support the use of systemic antibiotics 31 . Although most of the mentioned professionals concern about associating antibiotic with mechanical therapy, 33% of the professionals used antibiotic therapy alone.…”

“…However, some studies demonstrated that mechanical therapy used alone, may not combat adequately some types of periodontopathogens, making it difficult to obtain or re-establish periodontal health 1 . Studies demonstrated that the use of systemic antimicrobial agents adjunct to mechanical periodontal treatment may be an important therapeutic strategy in the treatment of chronic [2][3][4] and aggressive [5][6][7][8][9] periodontal diseases. These results were observed with the use of different antibiotics, such as amoxicillin/metronidazole 4,[8][9][10][11] , azythromicin [12][13][14] , clindamycin 15 and clarithromycin 16 , which showed favorable results as adjunct to therapy for aggressive periodontitis and chronic periodontal disease, when compared with the control group treated with mechanical therapy alone.…”

“…These results were observed with the use of different antibiotics, such as amoxicillin/metronidazole 4,[8][9][10][11] , azythromicin [12][13][14] , clindamycin 15 and clarithromycin 16 , which showed favorable results as adjunct to therapy for aggressive periodontitis and chronic periodontal disease, when compared with the control group treated with mechanical therapy alone. In addition to the effects of systemic antibiotic therapy based on the isolated use of a certain drug, the use of associations of antibiotics has also shown promising clinical and microbiological results 3,5,8,17 . Another factor of great importance for the correct indication of systemic antimicrobial agent use in therapy for periodontal alterations, in addition to the correct type of drug or association, is the occasion of using systemic antibiotic therapy.…”

Present and Future Non-Surgical Therapeutic Strategies for the Management of Periodontal Diseases

“…Several different treatment regimens have been employed successfully to manage periodontal diseases (Slots and Ting, 2002). Considering a number of studies, it can be stated generally that systemic antibiotic therapy has little effect on supragingival plaque accumulation with a possible exception in one study where doxycycline significantly decreased plaque accumulation at a twelve-week evaluation compared to placebo (Ng and Bissada, 1998 Except for the combination of metronidazole with amoxicillin, systemic antibiotic treatment produces no clinically significant effects on periodontal pocket depth reduction compared with controls (Winkel, et al, 2001) ( (Cionca, et al, 2009). A seven-day regimen of systemic metronidazole significantly reduced the percentage of sites with bleeding compared to controls (Watts, et al, 1986).…”

Antibiotic effects against periodontal bacteria in organ cultured tissue

“…Especially, the combination of amoxicillin trihydrate (AMX) and metronidazole (MTZ) appears to be highly effective by in vitro studies (Cionca, Giannopoulou, Ugolotti, & Mombelli, 2009, Ehmke, Moter, Beikler, Milian, & Flemmig, 2005, 2010; Feres et al, 2012, Goodson et al, 2012). Most of the previous studies evaluated the effects of antibiotics from clinical standpoint, and very few reports actually assessed antibiotic effects from systemic inflammatory responses.…”