The concomitant administration of systemic amoxicillin and metronidazole compared to scaling and root planing alone in treating periodontitis: =a systematic review=
Identifieur interne : 000411 ( Pmc/Checkpoint ); précédent : 000410; suivant : 000412The concomitant administration of systemic amoxicillin and metronidazole compared to scaling and root planing alone in treating periodontitis: =a systematic review=
Auteurs : Dina Zandbergen [Pays-Bas] ; Dagmar Else Slot [Pays-Bas] ; Richard Niederman [États-Unis] ; Fridus A. Van Der Weijden [Pays-Bas]Source :
- BMC Oral Health [ 1472-6831 ] ; 2016.
Abstract
The treatment of periodontitis begins with a non-surgical phase that includes scaling and root planing(SRP) and on occasion the use of systemic antibiotics. The goal was to systematically evaluate in systemic healthy adults the effect of the concomitant administration of amoxicillin (amx) and metronidazole (met) adjunctive to SRP compared to SRP alone.
The PubMed-MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to November 2014 to identify appropriate studies. Probing Pocket Depth (PD), Clinical Attachment Level (CAL), Bleeding on Pocket Probing(BOP) and Plaque Indices(PI) were selected as outcome variables. Based on the extracted data a meta-analysis was conducted.
A total of 526 unique articles were found, 20 studies met the eligibility criteria. A meta-analysis showed that SRP + amx + met provided significantly better effects overall and more pronounced PD reduction in periodontal pockets initially measuring ≥6 mm (DiffM:-0.86 mm,
Adjunctive systemic amoxicillin and metronidazole medication to SRP significantly improved the clinical outcomes with respect to mean PD, CAL and BOP compared to SRP alone. There is moderate to strong evidence in support of the recommendation that adjunctive amx + met therapy to SRP significantly improves the clinical outcomes, with respect to mean PD and CAL compared to SRP alone especially in initially deep (≥6 mm) pockets. No major side effects associated with the intake of amx + met were reported. This treatment regimen is an efficacious, minimally invasive, practical and inexpensive approach for periodontitis therapy. The key components are mechanical tooth and pocket debridement, supportive treatment of the disease with systemic antibiotics and attention to proper self-care.
The online version of this article (doi:10.1186/s12903-015-0123-6) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12903-015-0123-6
PubMed: 26928597
PubMed Central: 4770674
Affiliations:
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<author><name sortKey="Zandbergen, Dina" sort="Zandbergen, Dina" uniqKey="Zandbergen D" first="Dina" last="Zandbergen">Dina Zandbergen</name>
<affiliation wicri:level="1"><nlm:aff id="Aff1">Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands</nlm:aff>
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<author><name sortKey="Slot, Dagmar Else" sort="Slot, Dagmar Else" uniqKey="Slot D" first="Dagmar Else" last="Slot">Dagmar Else Slot</name>
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<wicri:regionArea>Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Gustav Mahlerlaan 3004, 1081 LA Amsterdam</wicri:regionArea>
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<author><name sortKey="Niederman, Richard" sort="Niederman, Richard" uniqKey="Niederman R" first="Richard" last="Niederman">Richard Niederman</name>
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<author><name sortKey="Van Der Weijden, Fridus A" sort="Van Der Weijden, Fridus A" uniqKey="Van Der Weijden F" first="Fridus A." last="Van Der Weijden">Fridus A. Van Der Weijden</name>
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<wicri:regionArea>Clinic for Periodontology, Livingstonelaan 466, 3526 JB Utrecht</wicri:regionArea>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>The treatment of periodontitis begins with a non-surgical phase that includes scaling and root planing(SRP) and on occasion the use of systemic antibiotics. The goal was to systematically evaluate in systemic healthy adults the effect of the concomitant administration of amoxicillin (amx) and metronidazole (met) adjunctive to SRP compared to SRP alone.</p>
</sec>
<sec><title>Methods</title>
<p>The PubMed-MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to November 2014 to identify appropriate studies. Probing Pocket Depth (PD), Clinical Attachment Level (CAL), Bleeding on Pocket Probing(BOP) and Plaque Indices(PI) were selected as outcome variables. Based on the extracted data a meta-analysis was conducted.</p>
</sec>
<sec><title>Results</title>
<p>A total of 526 unique articles were found, 20 studies met the eligibility criteria. A meta-analysis showed that SRP + amx + met provided significantly better effects overall and more pronounced PD reduction in periodontal pockets initially measuring ≥6 mm (DiffM:-0.86 mm, <italic>p</italic>
< 0.00001) and gain in CAL(DiffM:+0.75 mm, <italic>p</italic>
= 0.0001). The meta-analysis for the secondary inflammatory parameter BOP showed that SRP + amx + met provided full mouth significantly greater reduction in BOP than SRP alone (DiffM:-6.98 %, <italic>p</italic>
= 0.0001).</p>
</sec>
<sec><title>Conclusion</title>
<p>Adjunctive systemic amoxicillin and metronidazole medication to SRP significantly improved the clinical outcomes with respect to mean PD, CAL and BOP compared to SRP alone. There is moderate to strong evidence in support of the recommendation that adjunctive amx + met therapy to SRP significantly improves the clinical outcomes, with respect to mean PD and CAL compared to SRP alone especially in initially deep (≥6 mm) pockets. No major side effects associated with the intake of amx + met were reported. This treatment regimen is an efficacious, minimally invasive, practical and inexpensive approach for periodontitis therapy. The key components are mechanical tooth and pocket debridement, supportive treatment of the disease with systemic antibiotics and attention to proper self-care.</p>
</sec>
<sec><title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/s12903-015-0123-6) contains supplementary material, which is available to authorized users.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Oral Health</journal-id>
<journal-id journal-id-type="iso-abbrev">BMC Oral Health</journal-id>
<journal-title-group><journal-title>BMC Oral Health</journal-title>
</journal-title-group>
<issn pub-type="epub">1472-6831</issn>
<publisher><publisher-name>BioMed Central</publisher-name>
<publisher-loc>London</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">26928597</article-id>
<article-id pub-id-type="pmc">4770674</article-id>
<article-id pub-id-type="publisher-id">123</article-id>
<article-id pub-id-type="doi">10.1186/s12903-015-0123-6</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>The concomitant administration of systemic amoxicillin and metronidazole compared to scaling and root planing alone in treating periodontitis: =a systematic review=</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Zandbergen</surname>
<given-names>Dina</given-names>
</name>
<address><email>d.zandbergen@acta.nl</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
</contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Slot</surname>
<given-names>Dagmar Else</given-names>
</name>
<address><phone>+(31)-20-5980 179/307</phone>
<email>D.Slot@acta.nl</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Niederman</surname>
<given-names>Richard</given-names>
</name>
<address><email>rniederman@nyu.edu</email>
</address>
<xref ref-type="aff" rid="Aff2"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Van der Weijden</surname>
<given-names>Fridus A.</given-names>
</name>
<address><email>g.vd.weijden@acta.nl</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
<xref ref-type="aff" rid="Aff3"></xref>
</contrib>
<aff id="Aff1"><label></label>
Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands</aff>
<aff id="Aff2"><label></label>
College of Dentistry, New York University, 345 E. 24th Street, New York, NY 10010 USA</aff>
<aff id="Aff3"><label></label>
Clinic for Periodontology, Livingstonelaan 466, 3526 JB Utrecht, The Netherlands</aff>
</contrib-group>
<pub-date pub-type="epub"><day>29</day>
<month>2</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>29</day>
<month>2</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="collection"><year>2016</year>
</pub-date>
<volume>16</volume>
<elocation-id>27</elocation-id>
<history><date date-type="received"><day>9</day>
<month>4</month>
<year>2015</year>
</date>
<date date-type="accepted"><day>19</day>
<month>10</month>
<year>2015</year>
</date>
</history>
<permissions><copyright-statement>© Zandbergen et al. 2016</copyright-statement>
<license license-type="OpenAccess"><license-p><bold>Open Access</bold>
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>
) applies to the data made available in this article, unless otherwise stated.</license-p>
</license>
</permissions>
<abstract id="Abs1"><sec><title>Background</title>
<p>The treatment of periodontitis begins with a non-surgical phase that includes scaling and root planing(SRP) and on occasion the use of systemic antibiotics. The goal was to systematically evaluate in systemic healthy adults the effect of the concomitant administration of amoxicillin (amx) and metronidazole (met) adjunctive to SRP compared to SRP alone.</p>
</sec>
<sec><title>Methods</title>
<p>The PubMed-MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to November 2014 to identify appropriate studies. Probing Pocket Depth (PD), Clinical Attachment Level (CAL), Bleeding on Pocket Probing(BOP) and Plaque Indices(PI) were selected as outcome variables. Based on the extracted data a meta-analysis was conducted.</p>
</sec>
<sec><title>Results</title>
<p>A total of 526 unique articles were found, 20 studies met the eligibility criteria. A meta-analysis showed that SRP + amx + met provided significantly better effects overall and more pronounced PD reduction in periodontal pockets initially measuring ≥6 mm (DiffM:-0.86 mm, <italic>p</italic>
< 0.00001) and gain in CAL(DiffM:+0.75 mm, <italic>p</italic>
= 0.0001). The meta-analysis for the secondary inflammatory parameter BOP showed that SRP + amx + met provided full mouth significantly greater reduction in BOP than SRP alone (DiffM:-6.98 %, <italic>p</italic>
= 0.0001).</p>
</sec>
<sec><title>Conclusion</title>
<p>Adjunctive systemic amoxicillin and metronidazole medication to SRP significantly improved the clinical outcomes with respect to mean PD, CAL and BOP compared to SRP alone. There is moderate to strong evidence in support of the recommendation that adjunctive amx + met therapy to SRP significantly improves the clinical outcomes, with respect to mean PD and CAL compared to SRP alone especially in initially deep (≥6 mm) pockets. No major side effects associated with the intake of amx + met were reported. This treatment regimen is an efficacious, minimally invasive, practical and inexpensive approach for periodontitis therapy. The key components are mechanical tooth and pocket debridement, supportive treatment of the disease with systemic antibiotics and attention to proper self-care.</p>
</sec>
<sec><title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/s12903-015-0123-6) contains supplementary material, which is available to authorized users.</p>
</sec>
</abstract>
<kwd-group xml:lang="en"><title>Keywords</title>
<kwd>Periodontal therapy</kwd>
<kwd>Scaling and root planning</kwd>
<kwd>Systemic antibiotics</kwd>
<kwd>Amoxicillin</kwd>
<kwd>Metronidazole</kwd>
<kwd>Periodontitis</kwd>
<kwd>Antimicrobial drug</kwd>
<kwd>Non-surgical periodontal therapy</kwd>
<kwd>Systematic review</kwd>
<kwd>Evidence based dentistry</kwd>
</kwd-group>
<custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name>
<meta-value>© The Author(s) 2016</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Pays-Bas</li>
<li>États-Unis</li>
</country>
<region><li>État de New York</li>
</region>
</list>
<tree><country name="Pays-Bas"><noRegion><name sortKey="Zandbergen, Dina" sort="Zandbergen, Dina" uniqKey="Zandbergen D" first="Dina" last="Zandbergen">Dina Zandbergen</name>
</noRegion>
<name sortKey="Slot, Dagmar Else" sort="Slot, Dagmar Else" uniqKey="Slot D" first="Dagmar Else" last="Slot">Dagmar Else Slot</name>
<name sortKey="Van Der Weijden, Fridus A" sort="Van Der Weijden, Fridus A" uniqKey="Van Der Weijden F" first="Fridus A." last="Van Der Weijden">Fridus A. Van Der Weijden</name>
<name sortKey="Van Der Weijden, Fridus A" sort="Van Der Weijden, Fridus A" uniqKey="Van Der Weijden F" first="Fridus A." last="Van Der Weijden">Fridus A. Van Der Weijden</name>
</country>
<country name="États-Unis"><region name="État de New York"><name sortKey="Niederman, Richard" sort="Niederman, Richard" uniqKey="Niederman R" first="Richard" last="Niederman">Richard Niederman</name>
</region>
</country>
</tree>
</affiliations>
</record>
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