Systemic antibiotics as an adjunct to non-surgical periodontal treatment


Systemic and locally delivered antibiotics have been used as an adjunct to scaling and root planing (SRP) for the treatment of periodontal disease for many years. The aim of this review was to systematically evaluate the data concerning the effect of the concomitant administration of amoxicillin and metronidazole adjunctive to SRP in otherwise healthy adults.

Only the abstract was available for review but a good selection of databases has been used to search for potential studies (MEDLINE, Cochrane-CENTRAL and EMBASE) and they included 34 papers describing 27 clinical trials. The outcomes they were assessing were Probing Pocket Depth (PD), Clinical Attachment Level (CAL), Bleeding on Probing (BOP) and Plaque Index (PI) although only those for PD and CAL are reported in the abstract.

  • The full-mouth weighted mean change for PD showed an improvement of 1.43 mm.
  • The full-mouth weighted mean change for CAL showed a gain of 0.94 mm.

They concluded

From this review it is concluded that systemic antimicrobial therapy using a combination of amoxicillin and metronidazole as an adjunct to SRP can enhance the clinical benefits of non-surgical periodontal therapy in otherwise healthy adults.

Zandbergen D, Slot DE, Cobb CM, Van der Weijden FA. The Clinical Effect of Scaling and Root Planing and The Concomitant Administration of Systemic Amoxicillin and Metronidazole: A Systematic Review. J Periodontol. 2012 May 21.[Epub ahead of print] PubMed PMID: 22612369.

Comment and Related reviews

From the abstract is not possible to say whether the changes in PD and CAL are additional to those achieved by SRP alone so the full paper needs to be assessed to understand the clinical importance of the authos findings and whether they found any impact on the other outcomes they were assessing.

A number of related reviews  are available,  the most recent by Sgolastra et al  we highlighted earlier in the year.

Sgolastra F, Gatto R, Petrucci A, Monaco A. Effectiveness of Systemic Amoxicillin/Metronidazole as Adjunctive Therapy to Scaling and Root Planing in the Treatment of Chronic Periodontitis: A Systematic Review and Meta-Analysis. J Periodontol. 2012 Feb 14. [Epub ahead of print] PubMed PMID: 22220767.

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:.

Sgolastra F, Petrucci A, Gatto R, Giannoni M, Monaco A. Long-term efficacy of subantimicrobial-dose doxycycline as an adjunctive treatment to scaling and root planing: a systematic review and meta-analysis. J Periodontol. 2011 Nov;82(11):1570-81. doi: 10.1902/jop.2011.110026. Epub 2011 Mar 21. Review.PubMed PMID: 21417590.

Angaji M, Gelskey S, Nogueira-Filho G, Brothwell D. A systematic review of clinical efficacy of adjunctive antibiotics in the treatment of smokers with periodontitis. J Periodontol. 2010 Nov;81(11):1518-28. Epub 2010 Jun 28. Review. PubMed PMID: 20583918.

Herrera D, Alonso B, León R, Roldán S, Sanz M. Antimicrobial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm. J Clin Periodontol. 2008 Sep;35(8 Suppl):45-66. Review. PubMed PMID: 18724841.

Bonito AJ, Lux L, Lohr KN. Impact of local adjuncts to scaling and root planing in periodontal disease therapy: a systematic review. J Periodontol. 2005 Aug;76(8):1227-36. Review. Erratum in: J Periodontol. 2006 Feb;77(2):326. PubMed PMID: 16101353.




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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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