Amoxicillin and metronidazole as an adjunct to full-mouth scaling and root planing of chronic periodontitis.
BACKGROUND
It has been suggested that scaling and root planing of all pockets within a few hours and chlorhexidine treatments (full-mouth disinfection) may reduce the need for supplementary therapies. The aim of this study was to evaluate the clinical benefit of amoxicillin and metronidazole administered immediately after completion of full-mouth periodontal debridement in patients with chronic periodontitis.


METHODS
This was a single-center, double-masked, placebo-controlled, randomized longitudinal study of 6 months' duration. Fifty-one patients received full-mouth periodontal debridement, performed within 48 hours. Twenty-five subjects received metronidazole, 500 mg, and amoxicillin, 375 mg, three times a day for 7 days; 26 subjects received a placebo.


RESULTS
Forty-seven patients could be followed up to month 6. No differences in clinical parameters were noted before treatment. The overall mean probing depth decreased from 4.3 +/- 0.4 mm to 3.0 +/- 0.2 mm in the test group and from 4.4 +/- 0.4 mm to 3.1 +/- 0.3 mm in the control group (P = 0.05, difference between groups). More importantly, test subjects had a significantly lower mean number of persisting pockets >4 mm and bleeding on probing that required further treatment (P = 0.005): 6 months after full-mouth debridement plus antibiotics, only 0.4 +/- 0.8 persisting pockets were still present, whereas 3.0 +/- 4.3 persisting pockets were still present in the control group. The protective risk of the antibiotics for having more than one pocket deeper than 4 mm and bleeding on probing per subject after 6 months was 8.85.


CONCLUSIONS
Systemic metronidazole and amoxicillin significantly improved the 6-month clinical outcomes of full-mouth non-surgical periodontal debridement, thus significantly reducing the need for additional therapy.
Cionca
Norbert
N
Department of Periodontology, University of Geneva, Geneva, Switzerland. norbert.cionca@unige.ch
Giannopoulou
Catherine
C
Ugolotti
Giovanni
G
Mombelli
Andrea
A
D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000188:drug therapy / Q000628:therapy; D000658:Amoxicillin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use; D055113:Chronic Periodontitis / Q000188:drug therapy / Q000628:therapy*; D012534:Dental Scaling; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D005884:Gingival Hemorrhage / Q000188:drug therapy / Q000628:therapy; D005889:Gingival Recession / Q000188:drug therapy / Q000628:therapy; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage*; D008875:Middle Aged; D009067:Mouthwashes / Q000008:administration & dosage / Q000627:therapeutic use; D017622:Periodontal Attachment Loss / Q000188:drug therapy / Q000628:therapy; D010514:Periodontal Pocket / Q000188:drug therapy / Q000628:therapy; D010919:Placebos; D016745:Root Planing; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000891:Anti-Infective Agents, Local; D004338:Drug Combinations; D009067:Mouthwashes; D010919:Placebos; D008795:Metronidazole; D000658:Amoxicillin; D002710:Chlorhexidine