Impact of baseline microbiological status on clinical outcomes in generalized aggressive periodontitis patients treated with or without adjunctive amoxicillin and metronidazole: an exploratory analysis from a randomized controlled clinical trial

Abstract

All subjects benefited from the tested adjunctive antimicrobial regimen, although subjects who harboured A. actinomycetemcomitans at baseline may show greater clinical benefits. Larger appropriately powered studies are needed to confirm whether adjunctive AMX-MET is more beneficial for GAgP patients who harbour A. actinomycetemcomitans, along with other key periodontal pathogens.

Empirical or microbiologically guided systemic antimicrobials as adjuncts to non‐surgical periodontal therapy? A systematic review

“…When baseline subgingival microbial data were considered, Ardila and co‐workers (using moxifloxacin as adjunct) reported differences favouring the antibiotic group in A. actinomycetemcomitans +ve versus A. actinomycetemcomitans −ve for PPDs ≥ 7 mm (1.96 mm vs. 1.14 mm, respectively) and for PPDs 4–6 mm (0.92 mm vs. 0.51 mm, respectively) (Ardila & Guzman, ). Similarly, Guerrero and co‐workers reported that the percentage of sites changing from ≥5 mm to ≤4 mm PPDs at 6 months was 80.9% for A. actinomycetemcomitans +ve individuals treated with adjunctive antibiotics, compared to 71.1% for A. actinomycetemcomitans −ve individuals treated with adjunctive antibiotics (Guerrero et al, ). In contrast, when no antibiotics were prescribed, the change from ≥5 mm to ≤4 mm PPDs was found to be 52.6% for A. actinomycetemcomitans +ve and 60.9% for A. actinomycetemcomitans −ve individuals.…”

“…In contrast, when no antibiotics were prescribed, the change from ≥5 mm to ≤4 mm PPDs was found to be 52.6% for A. actinomycetemcomitans +ve and 60.9% for A. actinomycetemcomitans −ve individuals. Overall, both Guerrero and co‐workers and Ardila and co‐workers suggested that all patients benefitted from the antibiotic adjunct, although its clinical effect seemed to be more pronounced (but not statistically significant) in A. actinomycetemcomitans +ve patients (Ardila & Guzman, ; Guerrero et al, ). On the contrary, Cionca and co‐workers concluded that the adjunctive clinical benefits attributable to the antibiotic were obtained regardless of the baseline presence or absence of the six studied periodontal pathogens (Cionca et al, ).…”

“…All studies were RCTs and were published from 2005 to 2017. The target population was generalized aggressive periodontitis (GAgP) in three studies (Ardila & Guzman, ; Guerrero et al, ; Mestnik et al, ) and chronic periodontitis (CP) in two studies, including moderate CP (Cionca et al, ) and moderate to severe CP (Soares et al, ). The study follow‐ups ranged from 6 to 12 months.…”

“…Meta‐analysis for other available clinical data was possible for three papers (Guerrero et al, ; Mestnik et al, ; Soares et al, ) using adjunctive amoxicillin and metronidazole. Meta‐analyses revealed no statistically significant differences in the effect of the antibiotic regime for A. actinomycetemcomitans +ve versus A. actinomycetemcomitans −ve for mean PPD at 6 months in sites which had PPD ≥ 7 mm at baseline (Figure ), mean CAL at 6 months in sites which had PPD ≥ 7 mm at baseline (Figure ) and mean CAL at 6 months in sites which had PPD 4–6 mm at baseline (Figure ).…”

“…The adjunctive use of systemic antibiotics has shown to be beneficial, especially but not exclusively in patients with aggressive periodontitis, in terms of improvements in clinical parameters (probing pocket depths, PPD, and clinical attachment levels, CAL) compared with placebo (Haffajee, Socransky, & Gunsolley, ; Herrera, Sanz, Jepsen, Needleman, & Roldán, ; Jepsen & Jepsen, ; Sgolastra, Petrucci, Gatto, & Monaco, ; Smiley et al, ; Zandbergen, Slot, Niederman, & Weijden, ), although the long‐term stability of such improvements is probably highly influenced by the supportive periodontal therapy regime adopted (Ramberg et al, ). However, conflicting evidence has been reported on whether the baseline subgingival detection of the specific bacteria that the antibiotics have been introduced to target affects the clinical improvements when antibiotics are given or not (Cionca, Giannopoulou, Ugolotti, & Mombelli, ; Guerrero et al, ). A recent retrospective study suggested that microbiological analysis could inform a clinically based decision for the adjunctive use of systemic antibiotics (Eick et al, ).…”