title: The concomitant administration of systemic amoxicillin and metronidazole compared to scaling and root planing alone in treating periodontitis: =a systematic review=.
abstract: BACKGROUND
  The treatment of periodontitis begins with a non-surgical phase that includes scaling and root planing(SRP) and on occasion the use of systemic antibiotics. The goal was to systematically evaluate in systemic healthy adults the effect of the concomitant administration of amoxicillin (amx) and metronidazole (met) adjunctive to SRP compared to SRP alone.
  
  
  METHODS
  The PubMed-MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to November 2014 to identify appropriate studies. Probing Pocket Depth (PD), Clinical Attachment Level (CAL), Bleeding on Pocket Probing(BOP) and Plaque Indices(PI) were selected as outcome variables. Based on the extracted data a meta-analysis was conducted.
  
  
  RESULTS
  A total of 526 unique articles were found, 20 studies met the eligibility criteria. A meta-analysis showed that SRP + amx + met provided significantly better effects overall and more pronounced PD reduction in periodontal pockets initially measuring ≥6 mm (DiffM:-0.86 mm, p < 0.00001) and gain in CAL(DiffM:+0.75 mm, p = 0.0001). The meta-analysis for the secondary inflammatory parameter BOP showed that SRP + amx + met provided full mouth significantly greater reduction in BOP than SRP alone (DiffM:-6.98 %, p = 0.0001).
  
  
  CONCLUSIONS
  Adjunctive systemic amoxicillin and metronidazole medication to SRP significantly improved the clinical outcomes with respect to mean PD, CAL and BOP compared to SRP alone. There is moderate to strong evidence in support of the recommendation that adjunctive amx + met therapy to SRP significantly improves the clinical outcomes, with respect to mean PD and CAL compared to SRP alone especially in initially deep (≥6 mm) pockets. No major side effects associated with the intake of amx + met were reported. This treatment regimen is an efficacious, minimally invasive, practical and inexpensive approach for periodontitis therapy. The key components are mechanical tooth and pocket debridement, supportive treatment of the disease with systemic antibiotics and attention to proper self-care.
authors.affiliation: Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Gustav Mahlerlaan 3004, 1081, LA, Amsterdam, The Netherlands. d.zandbergen@acta.nl.
authors.forename: Dina
authors.initials: D
authors.lastname: Zandbergen
authors.affiliation: Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Gustav Mahlerlaan 3004, 1081, LA, Amsterdam, The Netherlands. D.Slot@acta.nl.
authors.forename: Dagmar Else
authors.initials: DE
authors.lastname: Slot
authors.affiliation: College of Dentistry, New York University, 345 E. 24th Street, New York, NY, 10010, USA. rniederman@nyu.edu.
authors.forename: Richard
authors.initials: R
authors.lastname: Niederman
authors.affiliation: Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Gustav Mahlerlaan 3004, 1081, LA, Amsterdam, The Netherlands. g.vd.weijden@acta.nl.|Clinic for Periodontology, Livingstonelaan 466, 3526 JB, Utrecht, The Netherlands. g.vd.weijden@acta.nl.
authors.forename: Fridus A
authors.initials: FA
authors.lastname: Van der Weijden
mesh_terms: D000658:Amoxicillin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D012534:Dental Scaling; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage*; D010514:Periodontal Pocket / Q000188:drug therapy; D010518:Periodontitis / Q000188:drug therapy* / Q000628:therapy; D016745:Root Planing; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D000658:Amoxicillin