Antibiotics in the Treatment of Periodontitis: A Systematic Review of the Literature

Abstract

Introduction. Systemic antibiotics present one of the alternative adjunctive therapies in nonsurgical periodontal treatment (NSPT). Different protocols have been proposed, but their indication and effectiveness are still controversial. The aim of this study is to assess the effectiveness of the addition of antibiotics after nonsurgical debridement during initial therapy and compare different antimicrobial prescription protocols. Materials and Methods. An electronic search was performed through MEDLINE and EBSCOhost databases using the appropriate MeSH words. The target studies have to be published during the last five years. Data from the selected studies were extracted and analyzed. Study selection was done based on inclusion and exclusion criteria. Results. Seven randomized clinical trials were included in our review. Their data were extracted using a grid established for this purpose. Collectively, different protocols have been proposed and almost all of them yield superior clinical and microbiological results compared to the placebo group. Conclusion. The overall findings of this review show a positive effect of the use of antibiotics as an adjunctive to NSPT, regardless of the antimicrobial agents used in our included studies. Sites with PD > 6 mm may benefit most from the adjunctive use of antibiotics in NSPT. This trial is registered with Clinicaltrials.gov identifiers: NCT02829983 (Bechara Andere et al., 2016); NCT02839421 (Ardila et al., 2020); NCT02735395 (Borges et al., 2017); NCT02359721 (Suryaprasanna et al., 2018); and NCT01318928 (Hans, 2015).

Clinical and Microbiological Efficacy of Adjunctive Systemic Quinolones to Mechanical Therapy in Periodontitis: A Systematic Review of the Literature

“…The results of this review do not show statistically significant differences in BOP levels when comparing experimental and control groups during follow-up. Similar results were described by a recent review [ 6 ].…”

“…Different systematic reviews have shown an additional benefit when adjunctive antimicrobials are used [ 1 , 6 – 8 ]. However, a consensus has suggested that these additional benefits are of clinical importance in patients with severe periodontitis aged 55 years and younger [ 1 ].…”

“…However, a consensus has suggested that these additional benefits are of clinical importance in patients with severe periodontitis aged 55 years and younger [ 1 ]. Moreover, scientific evidence has revealed that in these cases, the best management for treating periodontitis is mechanical therapy (subgingival debridement) plus amoxicillin/metronidazole (A + M) ( [ 1 , 6 – 9 ]. Nevertheless, it is fundamental to accentuate that A + M must be recommended with care because several periodontopathogens have shown antimicrobial resistance in diverse countries [ 10 – 13 ].…”

“…Different systematic reviews have also indicated the importance of evaluating the permanence of the results of clinical trials with adjuvants for the treatment of periodontitis during a follow-up period of at least 6 months [ 1 , 6 – 8 ].…”

Paraprobiotics in Non-Surgical Periodontal Therapy: Clinical and Microbiological Aspects in a 6-Month Follow-Up Domiciliary Protocol for Oral Hygiene

“…PDT exerted significant improvements both in clinical and microbiological load after one month, and these results were maintained 6 months after when compared to chlorhexidine rinsing or SRP alone, especially in severe periodontitis cases. As regards antibiotic therapy in non-surgical periodontal therapy, a recent systematic review stated that almost all the clinical trials included yielded superior clinical and microbiological results compared to the placebo group, and the positive effect of the use of antibiotics as an adjunctive to NSPT was assessed regardless of the antimicrobial agents used in the included studies [40]. In particular, sites with PPD > 6 mm may benefit most from the adjunctive use of antibiotics in NSPT.…”