Is progression of periodontitis relevantly influenced by systemic antibiotics? A clinical randomized trial

Abstract

AimWe investigated the long‐term impact of adjunctive systemic antibiotics on periodontal disease progression. Periodontal therapy is frequently supplemented by systemic antibiotics, although its impact on the course of disease is still unclear.Material & MethodsThis prospective, randomized, double‐blind, placebo‐controlled multi‐centre trial comprising patients suffering from moderate to severe periodontitis evaluated the impact of rational adjunctive use of systemic amoxicillin 500 mg plus metronidazole 400 mg (3x/day, 7 days) on attachment loss. The primary outcome was the percentage of sites showing further attachment loss (PSAL) ≥1.3 mm after the 27.5 months observation period. Standardized therapy comprised mechanical debridement in conjunction with antibiotics or placebo administration, and maintenance therapy at 3 months intervals.ResultsFrom 506 participating patients, 406 were included in the intention to treat analysis. Median PSAL observed in placebo group was 7.8% compared to 5.3% in antibiotics group (Q25 4.7%/Q75 14.1%; Q25 3.1%/Q75 9.9%; p < 0.001 respectively).ConclusionsBoth treatments were effective in preventing disease progression. Compared to placebo, the prescription of empiric adjunctive systemic antibiotics showed a small absolute, although statistically significant, additional reduction in further attachment loss. Therapists should consider the patient's overall risk for periodontal disease when deciding for or against adjunctive antibiotics prescription.

Is furcation involvement affected by adjunctive systemic amoxicillin plus metronidazole? A clinical trials exploratory subanalysis

“…These results confirm the observation at all sites (Harks et al. ). However, regarding frequency of furcation degrees, the subanalysis failed to find statistically noticeably differences between both groups.…”

“…Measurements were carried out by masked examiners not involved in periodontal therapy (Harks et al. , ).…”

“…,b), but a recent large controlled study shows only limited benefit on further attachment loss (Harks et al. ).…”

Different antibiotic protocols in the treatment of severe chronic periodontitis: A 1‐year randomized trial

“…The association of scaling and root planing (SRP) with systemic metronidazole (MTZ) and amoxicillin (AMX) has been suggested as an effective therapeutic protocol for the treatment of severe periodontitis, since 1989 (van Winkelhoff et al., ). This protocol has gained additional strength after the publication of five systematic reviews on the topic (Rabelo et al., ; Sgolastra, Gatto, Petrucci, & Monaco, ; Sgolastra, Petrucci, Gatto, & Monaco, ; Zandbergen, Slot, Cobb, & Van der Weijden, ; Zandbergen, Slot, Niederman, & Van der Weijden, ) and six randomized clinical trials (RCTs) showing that the clinical benefits of the adjunctive use of MTZ + AMX last for 1 to 2 years after antibiotic intake (Feres et al., ; Goodson et al., ; Harks et al., ; Mestnik et al., ; Mombelli, Almaghlouth, Cionca, Courvoisier, & Giannopoulou, ; Tamashiro et al., ).…”

Comparison of Two Different Sampling Methods for Subgingival Plaque: Subgingival Paper Points or Mouthrinse Sample?

“…Numerous studies have hypothesized that mechanical treatment alone may not be effective for certain patients and additional antimicrobial therapy would improve their clinical outcome 10,11,18,19 . Exact identification of patients who need systemic antibiotics is still unclear 20 . The main candidates have been patients showing further attachment loss even after adequate conventional therapy, patients with AgP or severe forms of periodontitis, or those with predisposing medical conditions 20 , 21 .…”