Metronidazole alone or with  amoxicillin as adjuncts to  non-surgical treatment of chronic  periodontitis: a secondary  analysis of microbiological results  from a randomized clinical trial.
OBJECTIVE
To evaluate the changes occurring in the subgingival microbial profile of subjects with generalized chronic periodontitis (ChP) treated by scaling and root planing (SRP) alone or with metronidazole (MTZ) or MTZ + amoxicillin(AMX). A secondary aim was to examine a possible added effect of chlorhexidine(CHX) to these therapies.


METHODS
One hundred and eighteen subjects were randomly assigned to receive SRP-only or with MTZ [400 mg/thrice a day (TID)] or MTZ + AMX (500 mg/TID) for 14 days. Half of the subjects in each group rinsed with 0.12% CHX twice a day (BID) for 2 months. Nine subgingival plaque samples/subject were analysed by checkerboard DNA–DNA hybridization for 40 bacterial species at baseline, 3, 6 and 12 months post-therapy.


RESULTS
At 12 months, the antibiotic-treated groups harboured lower mean counts and proportions of key periodontal pathogens than the SRP group (p < 0.05). These benefits were observed at initially deep and shallow sites. Initial reductions in periodontal pathogens obtained with SRP partially rebound after 12 months. CHX rinsing enhanced the microbiological effects of the MTZ + AMX treatment in shallow sites.


CONCLUSIONS
The adjunctive use of MTZ and MTZ + AMX results in a greater reduction in the levels of periodontal pathogens in generalized ChP subjects compared to SRP alone.
Geisla M S
GM
Soares
Juliana A V
JA
Mendes
Maike P
MP
Silva
Marcelo
M
Faveri
Ricardo
R
Teles
Sigmund S
SS
Socransky
Xiaoshan
X
Wang
Luciene C
LC
Figueiredo
Magda
M
Feres
D000328:Adult; D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D058491:Bacterial Load / Q000187:drug effects; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use; D055113:Chronic Periodontitis / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy*; D003131:Combined Modality Therapy; D003773:Dental Plaque / Q000382:microbiology; D012534:Dental Scaling / Q000379:methods; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009067:Mouthwashes / Q000008:administration & dosage / Q000627:therapeutic use; D017622:Periodontal Attachment Loss / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy; D010514:Periodontal Pocket / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy; D010919:Placebos; D016745:Root Planing / Q000379:methods; 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