Some evidence to support adjunctive amoxicillin and metronidazole for treating patients with aggressive periodontitis

Assorted pills

Most people suffer with inflamed gums for time to time. However, approximately 10% of the population suffer from more severe gum problems (periodontitis) leading to loss of bone supporting the teeth and potentially loss of teeth.  The aim of this review was to assess the effectiveness of combined amoxicillin and metronidazole (AMX/MET) as an adjunctive treatment to full-mouth scaling root planing (FMSRP) compared with FMSRP alone in patients with aggressive periodontitis.

The authors searched eight databases and hand-searched ten international dental journals. The main outcome measures were clinical attachment level (CAL), reduction in probing depth (PD) with adverse events and other secondary outcomes being considered. The date were pooled using a random effects model. The weighted mean difference with 95% confidence interval (CI) was calculated for continuous outcomes, while risk difference (RD) with 95% CI was used for dichotomous data; heterogeneity was assessed with the Cochrane χ(2) and I(2) tests. The level of significance was set at p < 0.05.

Six randomized clinical trials were included and they found:-

  • A significant CAL gain (MD: 0.42; 95% CI: 0.23 -0.61; p < 0.05) and PD reduction (MD: 0.58; 95% CI: 0.39-0.77; p < 0.05) in favour of FMSRP + AMX/MET
  • No significant RD was found in the occurrence of adverse events (RD: 0.01; 95% CI: -0.02-0.04, p > 0.05).

The authors concluded:-

The findings of the meta-analysis seem to support the effectiveness and the clinical safety of FMSRP + AMX/MET; however, future studies are needed to confirm these results.

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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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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