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.
BACKGROUND
The combination of Amoxicillin and metronidazole (AMX/MET) as an adjunctive treatment to scaling root planing (SRP) has been proposed for the treatment of chronic periodontitis; however, its effectiveness and clinical safety remain to be defined. The purpose of the present meta-analysis is to assess the effectiveness of SRP + AMX/MET compared to SRP alone.


METHODS
An electronic search of eight databases from their earliest records through October 8, 2011 and a hand search of international dental journals for the last 15 years were conducted. Gain in clinical attachment level (CAL), reduction in probing depth (PD), secondary outcomes, and adverse events were analyzed. A random-effect model was used to pool the extracted data. The weighted mean difference (WMD) with 95% confidence interval (CI) was calculated for continuous outcomes; heterogeneity was assessed with the Cochrane χ(2) and I(2) tests. The level of significance was set at P <0.05.


RESULTS
After the selection process, four randomized clinical trials were included. Results of the meta-analysis showed significant CAL gain (WMD = 0.21; 95% CI = 0.02 to 0.4; P <0.05) and PD reduction (WMD = 0.43; 95% CI = 0.24 to 0.63; P <0.05) in favor of SRP + AMX/MET. No significant differences were found for bleeding on probing (WMD = 10.77; 95% CI = -3.43 to 24.97; P >0.05) or suppuration (WMD = 1.77; 95% CI = -1.7 to 5.24; P >0.05).


CONCLUSIONS
The findings of this meta-analysis seem to support the effectiveness of SRP + AMX/MET; however, future studies are needed to confirm these results.
Department of Health Sciences, School of Dentistry, University of L'Aquila, L'Aquila, Italy. fabrizio.sgolastra@gmail.com
Fabrizio
F
Sgolastra
Roberto
R
Gatto
Ambra
A
Petrucci
Annalisa
A
Monaco
D000284:Administration, Oral; D000658:Amoxicillin / Q000008:administration & dosage*; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D055113:Chronic Periodontitis / Q000188:drug therapy* / Q000628:therapy; D016001:Confidence Intervals; D012534:Dental Scaling; D004338:Drug Combinations; D006801:Humans; D016013:Likelihood Functions; D008795:Metronidazole / Q000008:administration & dosage*; D061214:Patient Safety; D010512:Periodontal Index; D017594:Publication Bias; D011785:Quality Assurance, Health Care; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D004338:Drug Combinations; D008795:Metronidazole; D000658:Amoxicillin