The effect of systemic antibiotics administered during the active phase of non-surgical periodontal therapy or after the healing phase: a systematic review

Abstract

Objective The aim of this systematic review was to compare the clinical effectiveness of systemic antibiotics administered in the active stage of periodontal treatment or after the healing phase.Material and Methods An electronic search was performed in the databases EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL), in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. A manual search of the reference list of selected studies and of review articles was also performed up to November 2013. Randomized Clinical Trials (RCT) that evaluated the systemic administration of antibiotics as adjuvants to scaling and root planning (SRP) at different phases of periodontal treatment were included. Systematic reviews and studies that evaluated subjects with systemic diseases and those that used subantimicrobial doses of antibiotics were excluded.Results The initial search identified 1,039 articles, of which seven were selected, and only one met the inclusion criteria. This study showed that subjects taking metronidazole and amoxicillin at the initial phase of treatment exhibited statistically significantly greater reduction in pocket depth and gain in clinical attachment level in initially deep sites (PD≥7 mm) than subjects taking antibiotics after healing (p<0.05). This comparison was conducted 2 months after antibiotic intake, at the healing phase.Conclusion To date, only one short-term RCT has directly compared different moments of systemic antibiotics administration, as adjuncts to SRP, in the treatment of periodontitis. Although the results of this study suggested some benefits for antibiotics intake during the active phase of therapy, these findings need to be confirmed by larger placebo-controlled randomized clinical trials with longer follow-up periods.

Effects of timing of adjunctive systemic antibiotics on the clinical outcome of periodontal therapy: A systematic review

“…The conclusion of this review is somewhat consistent with another previous systematic review that compared the clinical effectiveness of systemic antibiotics administered in the active stage of periodontal treatment or after the healing phase (8). Only one study (22) was included in this review which did not allow authors to draw any clear conclusion.…”

“…The optimal time of antimicrobial drug administration is another subject of discussion, as it remains controversial whether adjunctive systemic antibiotics should preferably be administered during the initial non-surgical phase, or during the subsequent re-treatment at reevaluation. At present, there is very little data to guide the selection of the most appropriate timing of antibiotic administration (8). Basing on some biological concepts, some studies recommend the use of systemic adjunctive antibiotic agents at the initial phase of treatment (9)(10)(11), as it was recommended in the consensus report of the sixth European Workshop on Periodontology (12).…”

Effect of local probiotic (Lactobacillus reuteri) vs systemic antibiotic therapy as an adjunct to non‐surgical periodontal treatment in chronic periodontitis

“…The use of adjunctive systemic antibiotics along with SRP for the treatment of CP is widely discussed and supported in the literature, but the dosage and duration of their use is still controversial . Studies report that antibiotics destroy non‐pathogenic resident microbiota, which provide natural resistance to pathogenic colonization, termed as “colonization resistance”, leading to dysbiosis and causing an increase in susceptibility to other bacterial infections .…”

A double‐masked Randomized Clinical Trial (RCT) comparing four periodontitis treatment strategies: 5‐year clinical results

“…The use of adjunct systemic antimicrobials in the treatment of periodontitis continues to prompt new systematic reviews and meta‐analyses. The majority of these reviews indicate a small additional clinical benefit of these drugs as compared to scaling and root planing alone (Fritoli et al., ; Herrera, Alonso, León, Roldán, & Sanz, ; Jepsen & Jepsen, ; Keestra, Grosjean, Coucke, Quirynen, & Teughels, ; Kolakovic, Held, Schmidlin, & Sahrmann, ; Santos et al., ; Sgolastra, Severino, Petrucci, Gatto, & Monaco, ; Slots & Ting, ; Smiley et al., ; Zandbergen, Slot, Niederman, & Van der Weijden, ). Regarding the question of the relative benefit of one‐day full‐mouth disinfection (FDIS) approach over the traditional quadrant‐based scaling and root planing (qSRP) approach, only a few systematic reviews exist (Eberhard, Jepsen, Jervøe‐Storm, Needleman, & Worthington, , ; Fang et al., ; Farman & Joshi, ; Lang, Tan, Krähenemann, & Zwalen, ).…”