Better outcomes with metronidazole and amoxicillin as an adjunct to full mouth disinfection for patients with aggressive periodontitis

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About 1 in 1000 susceptible patients suffers from aggressive periodontitis. Sufferers have more rapid  gingival attachment loss with some losing more that half their bony support by 35. This can be localised  to a small number of teeth or more generalised.  The aim of this study was to evaluate the adjunctive clinical and microbiological effects of the administration of systemic amoxicillin and metronidazole (AMX/MET) in the one-stage full mouth disinfection (OSFMD) protocol in generalized aggressive periodontitis (G-AgP) patients.

39 patients with G-AgP were randomised to either the test group of amoxicillin-metronidazole combination (500 mg of each, three times a day for 7 days) and OSFMD  or the control of  OSFMD and a placebo.

All patients received an initial session of supragingival scaling and polishing and advice on plaque control measures.  One week later they received OSFMD with full-mouth subgingival scaling and root planing  being performed in two sessions within 24hours.  Chlorhexidine (CHX) rinses and the antibiotic and placebo therapies started immediately after the first session of OSFMD. Patients were seen at 2-week intervals during the first 6 weeks post-operatively and every 2 months up to the 6-month evaluation. Outcomes were assessed at 3 and 6 months. The primary outcome measure of the study was reduction in mean full-mouth pocket depth (PD) values.

They found that at 6 months patients who took systemic antibiotics had a lower percentage of bleeding sites, a greater reduction in full mouth PD, and fewer sites with PD ≥ 5 mm in comparison with the placebo group  (17.7% in the test group versus 28.4% in the control one).  There was also a lower prevalence of Aggregatibacter actinomycetemcomitans, Treponema denticola, and Tannerella forsythia compared to the control group.

The authors concluded

Systemic administration of metronidazole and amoxicillin as an adjunct to OSFMD therapy significantly improved clinical and microbiological outcomes in patients with G-AgP over a 6-month period.

Aimetti M, Romano F, Guzzi N, Carnevale G. Full-mouth disinfection and systemic antimicrobial therapy in generalized aggressive periodontitis: a randomized, placebo-controlled trial. J Clin Periodontol. 2012 Jan 4. doi:10.1111/j.1600-051X.2011.01795.x. [Epub ahead of print] PubMed PMID:

Comment

A systematic review by Sgolastra et al (Dental Elf Jan 16th),  which included 4 randomised trials also provided some support for  AMX/MET.  We also noted at that time that  there are a number of other related reviews available.

Sgolastra F, Petrucci A, Gatto R, Monaco A. Effectiveness of Systemic Amoxicillin/Metronidazole as an Adjunctive Therapy to Full-Mouth Scaling and Root Planing in the Treatment of Aggressive Periodontitis: A Systematic Review and Meta-Analysis. J Periodontol. 2011 Nov 3. [Epub ahead of print] PubMed PMID:22050545.

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