Nonsurgical therapy of chronic periodontitis with adjunctive systemic azithromycin or amoxicillin/metronidazole

Abstract

Objectives: To compare the effect of systemic adjunctive use of azithromycin with amoxicillin/metronidazole to scaling and root planing (SRP) in a clinical study. Materials and Methods: Data from 60 individuals with chronic periodontitis were evaluated after full-mouth SRP. Antibiotics were given from the first day of SRP, in the test group (n=29) azithromycin for three days, in the control group (n=31) amoxicillin/metronidazole for seven days. Probing depth (PD), attachment level (AL) and bleeding on probing (BOP) were recorded at baseline and after 3 and 12 months. Gingival crevicular fluid was analyzed for MMP-8 and IL-1beta levels. Subgingival plaque was taken for assessment of the major bacteria associated with periodontitis. Results: In both groups, PD, AL and BOP were significantly reduced (p<0.001). A few significant differences between the groups were found; AL and BOP were significantly better in the test than in the control group at the end of the study (p=0.020 and 0.009). Periodontopathogens were reduced most in the test group. Conclusions: A noninferiority of the treatment with azithromycin in comparison with amoxicillin / metronidazole can be stated. The administration of azithromycin could be an alternative to the use of amoxicillin/metronidazole adjunctive to SRP in patients with moderate or severe chronic periodontitis, however a randomized placebo controlled multicenter study is needed. Clinical Relevance: Application of azithromycin as a single antibiotic for three days might be considered as an additional adjunctive antibiotic to SRP in selected patients.

Comparison of repeated applications of aPDT with amoxicillin and metronidazole in the treatment of chronic periodontitis: A short-term study

“…According to a meta-analysis, the use of systemic antibiotics in the nonsurgical treatment of periodontitis provides a statistically significant reduction of PD (0.55 ± 0.37 mm, average) after MTZ + AMX use compared to isolated SRP 12 months post-treatment [55]. In the treatment of chronic periodontitis, a majority of studies have used the combination of MTZ + AMX for a period of 7 days [15,16,[18][19][20]30,31,[56][57][58][59][60][61][62][63][64]; however, some authors used it for a period of 14 days [17,25,35,[65][66][67].…”

The impact of antimicrobial photodynamic therapy on peri-implant disease: What mechanisms are involved in this novel treatment?

“…In an attempt to reduce these numbers, antibiotic therapy is often recommended for patients receiving periodontitis and periimplantitis treatment procedures [14]. According to some authors, the advantage of antibiotic use is the short course of administration, which may contribute to patient compliance [15]. Despite the clinical relevance and the effective use of systemic antibiotics to treat numerous infectious diseases, the currently available scientific information on the use of these agents in the treatment of periodontal and peri-implant diseases is insufficient to support any official recommendations on the use of these medicines [16].…”

Professional tooth cleaning prior to non‐surgical periodontal therapy: A randomized clinical trial

“…Interestingly, after SRP the number of sites with PD ≥5 mm was more reduced in the group without professional tooth cleaning before SRP, the reduction was 58% or 50%, respectively. This is lower than a reduction of about 80% due to adjunctive use of photodynamic therapy or solely SRP or after adjunctive use of systemic antibiotics . After SRP Eick et al.…”

“…This is lower than a reduction of about 80% due to adjunctive use of photodynamic therapy or solely SRP or after adjunctive use of systemic antibiotics. 7,27 After SRP Eick et al found a reduction of 79% or 40% of sites with PD ≥5 mm for high or low responder after SRP. 28 Professional tooth cleaning improves the PD before SRP, but does not further improve the general outcome of the combined therapy (SRP with prior professional mechanical T A B L E 2 Clinical variables (mean ± SD) of the test group (two appointments of professional tooth cleaning before SRP) and control group (without professional tooth cleaning before SRP) at baseline (T0), 6 weeks before SRP (T1) and three (T2) and 6 months (T3) tooth cleaning).…”