title: Is progression of periodontitis relevantly influenced by systemic antibiotics? A clinical randomized trial.
abstract: OBJECTIVE
  We investigated the long-term impact of adjunctive systemic antibiotics on periodontal disease progression. Periodontal therapy is frequently supplemented by systemic antibiotics, although its impact on the course of disease is still unclear.
  
  
  METHODS
  This prospective, randomized, double-blind, placebo-controlled multi-centre trial comprising patients suffering from moderate to severe periodontitis evaluated the impact of rational adjunctive use of systemic amoxicillin 500 mg plus metronidazole 400 mg (3x/day, 7 days) on attachment loss. The primary outcome was the percentage of sites showing further attachment loss (PSAL) ≥1.3 mm after the 27.5 months observation period. Standardized therapy comprised mechanical debridement in conjunction with antibiotics or placebo administration, and maintenance therapy at 3 months intervals.
  
  
  RESULTS
  From 506 participating patients, 406 were included in the intention to treat analysis. Median PSAL observed in placebo group was 7.8% compared to 5.3% in antibiotics group (Q25 4.7%/Q75 14.1%; Q25 3.1%/Q75 9.9%; p < 0.001 respectively).
  
  
  CONCLUSIONS
  Both treatments were effective in preventing disease progression. Compared to placebo, the prescription of empiric adjunctive systemic antibiotics showed a small absolute, although statistically significant, additional reduction in further attachment loss. Therapists should consider the patient's overall risk for periodontal disease when deciding for or against adjunctive antibiotics prescription.
authors.affiliation: Department of Periodontology, University Hospital Münster, Münster, Germany.
authors.forename: Inga
authors.initials: I
authors.lastname: Harks
authors.affiliation: Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.
authors.forename: Raphael
authors.initials: R
authors.lastname: Koch
authors.affiliation: Department of Periodontology, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Eickholz
authors.affiliation: Department of Periodontology, TU Dresden, Dresden, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hoffmann
authors.affiliation: Section of Periodontology, Department of Conservative Dentistry, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Ti-Sun
authors.initials: TS
authors.lastname: Kim
authors.affiliation: Unit of Periodontology, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kocher
authors.affiliation: Department of Periodontology, University of Giessen, Giessen, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Meyle
authors.affiliation: Departments of Periodontology and Synoptic Dentistry, Charité Centrum 3, Charité-Universitätsmedizin Berlin, Berlin, Germany.|Department of Periodontology, Dental School, Faculty of Health, University of Witten/Herdecke, Witten, Germany.
authors.forename: Doğan
authors.initials: D
authors.lastname: Kaner
authors.affiliation: Department of Periodontology, University Hospital Würzburg, Würzburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schlagenhauf
authors.affiliation: Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria.
authors.forename: Stephan
authors.initials: S
authors.lastname: Doering
authors.affiliation: Unit of Periodontology, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Birte
authors.initials: B
authors.lastname: Holtfreter
authors.affiliation: Department of Periodontology, University Hospital Münster, Münster, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Gravemeier
authors.affiliation: Department of Periodontology, University Hospital Münster, Münster, Germany.
authors.forename: Dag
authors.initials: D
authors.lastname: Harmsen
authors.affiliation: Department of Periodontology, University Hospital Münster, Münster, Germany.
authors.forename: Benjamin
authors.identifier: http://orcid.org/0000-0002-2418-6765
authors.initials: B
authors.lastname: Ehmke
mesh_terms: D000658:Amoxicillin / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D018450:Disease Progression; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000009:adverse effects; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000209:etiology*; D010518:Periodontitis / Q000175:diagnosis* / Q000188:drug therapy*; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D000658:Amoxicillin
keywords: amoxicillin/metronidazole; attachment loss; clinical relevance; debridement; outcome parameter; periodontitis; randomised controlled trial; systemic antibiotics