title: Antimicrobial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm.
abstract: OBJECTIVE
  The aim was to answer three relevant questions: can systemic antimicrobials be efficacious if the biofilm is not disrupted? Can the type of debridement of the subgingival biofilm impact upon the clinical outcomes of the adjunctive antimicrobial therapy? Is the efficacy of the adjunctive systemic antimicrobial therapy dependent on the quality of the debridement of the subgingival biofilm and the sequence debridement-antibiotic usage?
  
  
  METHODS
  Relevant papers were searched, critically analysed and their data were extracted.
  
  
  RESULTS
  For the first question, studies assessing susceptibility of bacteria in biofilms, and clinical studies evaluating systemic antimicrobials as monotherapy, were reviewed. For the second question, clinical studies comparing systemic antimicrobials as adjuncts to non-surgical debridement or to periodontal surgery and clinical trials using systemic antibiotics with periodontal surgery were evaluated. For the third question, a previous systematic review was updated.
  
  
  CONCLUSIONS
  If systemic antimicrobials are indicated in periodontal therapy, they should be adjunctive to mechanical debridement. There is not enough evidence to support their use with periodontal surgery. Indirect evidence suggests that antibiotic intake should start on the day of debridement completion, debridement should be completed within a short time (preferably <1 week) and with an adequate quality, to optimize the results.
authors: ETEP Research Group, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain. davidher@odon.ucm.es
authors: David
authors: D
authors: Herrera
authors: Bettina
authors: B
authors: Alonso
authors: Rubén
authors: R
authors: León
authors: Silvia
authors: S
authors: Roldán
authors: Mariano
authors: M
authors: Sanz
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018441:Biofilms / Q000187:drug effects*; D003131:Combined Modality Therapy; D003646:Debridement; D012534:Dental Scaling; D004338:Drug Combinations; D024881:Drug Resistance, Bacterial; D006801:Humans; D010518:Periodontitis / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D016745:Root Planing; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations