title: Local and systemic antimicrobial therapy in periodontics.
abstract: BACKGROUND
  This review aimed to update the current evidence on the efficacy of the adjunctive use of local and systemic antimicrobials in the treatment of periodontitis and to assess whether it might improve the clinical limitations and shortcomings of standard nonsurgical treatment in the management of periodontitis.
  
  
  METHODS
  Relevant randomized clinical trials (RCT) with more than 3 months of follow-up, published from 2010 to 2012 for systemic antimicrobials and from 2008 to 2012 for local antimicrobials, were searched in Medline and critically analyzed. Scientific evidence evaluated in different systematic reviews and reviews presented at European and World Workshops were also included. Only adjunctive therapies were considered in the present review: articles comparing debridement alone or plus placebo, versus debridement plus systemic or local antimicrobials were included.
  
  
  RESULTS
  Adjunctive systemic antimicrobials have been evaluated both in aggressive and chronic periodontitis: in aggressive periodontitis, amoxicillin and metronidazole have been extensively studied, reporting clinical and microbiological benefits; in chronic periodontitis, different products are under scrutiny, such as azithromycin. The clinical efficacy of local antimicrobials, although extensively demonstrated, is still surrounded by a constant debate on the cost-effectiveness evaluation and on its adequate indications.
  
  
  CONCLUSIONS
  Despite the clinical efficacy of the adjunctive use of local and systemic antimicrobials, demonstrated in RCTs and in systematic reviews, there is a lack of evidence to support well-defined clinical protocols, including products and dosages.
authors.affiliation: Section of Graduate Periodontology Faculty of Dentistry, Complutense University, Madrid, Spain. davidher@odon.ucm.es
authors.forename: David
authors.initials: D
authors.lastname: Herrera
authors.forename: Paula
authors.initials: P
authors.lastname: Matesanz
authors.forename: Antonio
authors.initials: A
authors.lastname: Bascones-Martínez
authors.forename: Mariano
authors.initials: M
authors.lastname: Sanz
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003773:Dental Plaque / Q000188:drug therapy* / Q000628:therapy; D012534:Dental Scaling; D019468:Disease Management; D006801:Humans; D057747:Periodontal Debridement / Q000379:methods; D010518:Periodontitis / Q000188:drug therapy* / Q000628:therapy; D016745:Root Planing
chemical_list: D000890:Anti-Infective Agents