Comparison of adjunctive azithromycin and amoxicillin/metronidazole for patients with chronic periodontitis: preliminary randomized control trial

Saleh, Amy M.; Gómez-Rincón, Julio César; Tan, Albert E. S.; Firth, Martin J

doi:10.1111/adj.12415

Cited by 24 publications

(83 citation statements)

References 70 publications

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“…This ultimately emphasizes the importance of conventional SRP therapy for inducing the resolution of the inflammatory response and facilitating periodontal tissue healing. These results are also in accordance with similar studies in the literature that suggest that SRP + AMX + MTZ or SRP + AZ have no significantly greater improvements over SRP alone in full‐mouth clinical parameters . However, the clinical relevance of using full‐mouth CAL and PPD to describe treatment efficacy is highly controversial.…”

Section: Discussionsupporting

confidence: 89%

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Comparing the periodontal tissue response to non‐surgical scaling and root planing alone, adjunctive azithromycin, or adjunctive amoxicillin plus metronidazole in generalized chronic moderate‐to‐severe periodontitis: a preliminary randomized controlled trial

Liaw

Miller

Nimmo

2019

Australian Dental Journal

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Background: The usefulness of administrating adjunctive systemic antibiotics to expedite healing of periodontal tissues is a topic of interest given the lack of clear guidelines. Aim: To compare clinical outcomes in patients given adjunctive azithromycin (AZ), adjunctive amoxicillin plus metronidazole (AMX + MTZ), or scaling and root planing (SRP) alone in the treatment of moderate-to-severe chronic periodontitis. Methods: Thirty-eight patients were randomly assigned into: SRP alone; 500 mg AMX plus 400 mg MTZ three times per day for 7 days; or 500 mg AZ for 3 days. Antibiotics were administered after the first SRP session and clinical parameters for full-mouth and baseline probing pocket depth (PPD) categories were reviewed 2-months post-treatment. Results: Thirty-four of 38 patients completed the study. All groups experienced significant improvements in full-mouth clinical attachment level (CAL), probing pocket depth (PPD) and bleeding on probing. AZ exhibited greater reductions in PPD than SRP alone for baseline severe sites, whilst AMX+MTZ showed significant improvements in PPD and CAL than SRP alone for baseline moderate and severe sites. Of the two antibiotic therapies, AMX+MTZ showed greater reductions in PPD compared with AZ in baseline moderate sites only. Conclusions: For patients with moderate-to-severe periodontitis, adjunctive systemic antibiotics might result in greater clinical benefits.Keywords: Amoxicillin, azithromycin, chronic periodontitis, metronidazole, scaling and root planing.Abbreviations and acronyms: AMX + MTZ = amoxicillin plus metronidazole; AMX = amoxicillin; AZ = azithromycin; BOP = bleeding on probing; CAL = clinical attachment level; MTZ = metronidazole; PPD = probing pocket depth; RCT = randomized controlled trial; SRP = scaling and root planning; TID = three times per day.

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Section: Discussionsupporting

confidence: 89%

“…To date, only one randomized controlled trial (RCT) has directly compared the clinical effects of AMX + MTZ against AZ after SRP for the treatment of chronic periodontitis . This study found AMX + MTZ to be superior to AZ in only one full‐mouth clinical parameter and thus, further investigations are warranted.…”

Section: Introductionmentioning

confidence: 99%

Comparing the periodontal tissue response to non‐surgical scaling and root planing alone, adjunctive azithromycin, or adjunctive amoxicillin plus metronidazole in generalized chronic moderate‐to‐severe periodontitis: a preliminary randomized controlled trial

Liaw

Miller

Nimmo

2019

Australian Dental Journal

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“…The growing prevalence of antimicrobial resistance has prompted the development of new antimicrobial therapeutic approaches for the treatment of biofilm-related oral diseases. In the present study, the results obtained for PPD and CAL in deep pockets in the Test group at 90 postoperative days were similar to or higher to those obtained in some studies that used antibiotics as adjuvants to SRP for the treatment of chronic periodontitis (Feres et al, 2012;Saleh, Rincon, Tan, & Firth, 2016;Silva et al, 2011).…”

Section: Immunological Monitoringsupporting

confidence: 90%

Effects of Bifidobacterium probiotic on the treatment of chronic periodontitis: A randomized clinical trial

Invernici

Salvador

Silva

et al. 2018

J Clinic Periodontology

179

200

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AimThis randomized placebo‐controlled clinical trial evaluated the effect of Bifidobacterium animalis subsp. lactis (B. lactis) HN019‐containing probiotic lozenges as adjuvant to scaling and root planing (SRP) in patients with generalized chronic periodontitis.Materials and MethodsForty‐one chronic periodontitis patients were recruited and monitored clinically, immunologically, and microbiologically at baseline (before SRP) and 30 and 90 days after SRP. All patients were randomly assigned to a Test (SRP + Probiotic, n = 20) or Control (SRP + Placebo, n = 21) group. The probiotic lozenges were used twice a day for 30 days. The data were statistically analysed.ResultsThe Test group presented a decrease in probing pocket depth and a clinical attachment gain significantly higher than those of the Control group at 90 days. The Test group also demonstrated significantly fewer periodontal pathogens of red and orange complexes, as well as lower proinflammatory cytokine levels when compared to the Control group. Only the Test group showed an increase in the number of B. lactis HN019 DNA copies on subgingival biofilm at 30 and 90 days.ConclusionThe use of B. lactis HN019 as an adjunct to SRP promotes additional clinical, microbiological, and immunological benefits in the treatment of chronic periodontitis (NCT03408548).

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“…Furthermore, the reduction in PPD was greater in the same group. These results differ from those described in previous studies, where no signi cant differences between study groups were observed at any time points [13,18,19]. Otherwise, previous research [20,21] reported a signi cant reduction in the average PPD, consistent with this study.…”

Section: Discussioncontrasting

confidence: 66%

Effect of Periodontal Debridement Plus Systemic Azithromycin v/s Periodontal Debridement as Unique Therapy in Subjects with Periodontitis: A Randomized Controlled Clinical Trial.

Navarrete

Oñate

Loyola

et al. 2020

Preprint

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Background: Recently, it has been suggested that azithromycin (AZM) may be a useful adjunct to non-surgical periodontal therapy (NSPT). However, current scientific evidence is still not conclusive as to its efficacy as an adjunct of NSPT. This study aimed to evaluate the effect of the systemic administration of AZM as an adjunct to NSPT on the clinical and microbiological variables of patients with periodontitis.Methods: Eighteen volunteers with Periodontitis received NSPT combined with placebo or AZM (500 mg/day) for 3 days (n=9/group). They were monitored clinically for probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI) and bleeding on probing (BoP) at baseline and during the first, third and sixth month and monitored microbiologically at baseline and at 3 and 6 months after therapy. The microbiological variables were detected by conventional polymerase chain reaction tests. The normality was checked using the Shapiro-Wilk test. The level of statistical significance was measured by the unpaired t-test, Mann-Whitney U, Fisher’s exact and Chi-Square tests.Results: Fourteen patients completed the study (n=7/group). The group receiving NSPT + AZM presented with a significantly lower mean PPD at 3 (p = 0.05) and 6 months (p = 0.04) with a greater probing depth reduction (p = 0.02). Moreover, at the third month post NSPT, there was a significant increase in the number of sites with a PPD 1–3 mm (p < 0.001) and a decrease in the number of sites with a PPD 4–6 mm (p < 0.001). In addition, a significant decrease in the mean number of sites with a PPD ≥ 7 mm (p = 0.04) was detected at 6 months post treatment. There was also a significant decrease in BoP at 1 (p = 0.01), 3 (p < 0.001) and 6 (p = 0.01) months post intervention. Conclusions: AZM as an adjuvant to NSPT provides additional beneficial effects for PPD and BoP compared to NSPT alone. This could be related to its anti-inflammatory properties more than to its antibiotic characteristics.Trial registration: ClinicalTrials.gov: NCT03629288. https://clinicaltrials.gov/ct2/show/NCT03629288Retrospectively registered on August 14, 2018.

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Comparison of adjunctive azithromycin and amoxicillin/metronidazole for patients with chronic periodontitis: preliminary randomized control trial

Abstract: Adjunctive systemic antibiotics in the initial phase of treatment may result in improved clinical outcomes.

Cited by 24 publications

References 70 publications

Comparing the periodontal tissue response to non‐surgical scaling and root planing alone, adjunctive azithromycin, or adjunctive amoxicillin plus metronidazole in generalized chronic moderate‐to‐severe periodontitis: a preliminary randomized controlled trial

Comparing the periodontal tissue response to non‐surgical scaling and root planing alone, adjunctive azithromycin, or adjunctive amoxicillin plus metronidazole in generalized chronic moderate‐to‐severe periodontitis: a preliminary randomized controlled trial

Effects of Bifidobacterium probiotic on the treatment of chronic periodontitis: A randomized clinical trial

Effect of Periodontal Debridement Plus Systemic Azithromycin v/s Periodontal Debridement as Unique Therapy in Subjects with Periodontitis: A Randomized Controlled Clinical Trial.

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Comparison of adjunctive azithromycin and amoxicillin/metronidazole for patients with chronic periodontitis: preliminary randomized control trial

Abstract: Adjunctive systemic antibiotics in the initial phase of treatment may result in improved clinical outcomes.

Cited by 24 publications

References 70 publications

Comparing the periodontal tissue response to non‐surgical scaling and root planing alone, adjunctive azithromycin, or adjunctive amoxicillin plus metronidazole in generalized chronic moderate‐to‐severe periodontitis: a preliminary randomized controlled trial

Comparing the periodontal tissue response to non‐surgical scaling and root planing alone, adjunctive azithromycin, or adjunctive amoxicillin plus metronidazole in generalized chronic moderate‐to‐severe periodontitis: a preliminary randomized controlled trial

Effects of Bifidobacterium probiotic on the treatment of chronic periodontitis: A randomized clinical trial

Effect of Periodontal Debridement Plus Systemic Azithromycin v/s&nbsp;Periodontal Debridement as Unique Therapy in Subjects with Periodontitis: A Randomized Controlled Clinical Trial.

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Effect of Periodontal Debridement Plus Systemic Azithromycin v/s Periodontal Debridement as Unique Therapy in Subjects with Periodontitis: A Randomized Controlled Clinical Trial.