title: Amoxicillin Plus Metronidazole Therapy for Patients with Periodontitis and Type 2 Diabetes: A 2-year Randomized Controlled Trial.
abstract: The aim of this study was to assess the changes occurring in subgingival biofilm composition and in the periodontal clinical parameters of subjects with periodontitis and type 2 diabetes mellitus (DM) treated by means of scaling and root planing (SRP) only or combined with systemic metronidazole (MTZ) and amoxicillin (AMX). Fifty-eight subjects were randomly assigned to receive SRP only (n = 29) or with MTZ (400 mg/thrice a day [TID]) and AMX (500 mg/TID) (n = 29) for 14 d. Six subgingival plaque samples/subject were analyzed by checkerboard DNA-DNA hybridization for 40 bacterial species at baseline and 3 mo, 1 y, and 2 y posttherapy. At 2 y posttherapy, the antibiotic-treated group harbored lower mean proportions (5.5%) of red complex pathogens than the control group (12.1%) (P < 0.05). The proportions of the Actinomyces species remained stable in the antibiotic group but showed a statistically significant reduction in the control group from 1 to 2 y in subjects achieving a low risk clinical profile for future disease progression (i.e., ≤4 sites with probing depth [PD] ≥5 mm). The test group also had a lower mean number of sites with PD ≥5 mm (3.5 ± 3.4) and a higher percentage of subjects reaching the low risk clinical profile (76%) than the control group (14.7 ± 13.1 and 22%, respectively) (P < 0.05) at 2 y posttreatment. MTZ + AMX intake was the only significant predictor of subjects achieving the low risk at 2 y (odds ratio, 20.9; P = 0.0000). In conclusion, the results of this study showed that the adjunctive use of MTZ + AMX improves the microbiological and clinical outcomes of SRP in the treatment of subjects with generalized chronic periodontitis and type 2 DM up to 2 y (ClinicalTrials.gov NCT02135952).
authors.affiliation: Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil.
authors.forename: N S
authors.initials: NS
authors.lastname: Tamashiro
authors.affiliation: Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil.
authors.forename: P M
authors.initials: PM
authors.lastname: Duarte
authors.affiliation: Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil.
authors.forename: T S
authors.initials: TS
authors.lastname: Miranda
authors.affiliation: Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil.
authors.forename: S S
authors.initials: SS
authors.lastname: Maciel
authors.affiliation: Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil.
authors.forename: L C
authors.initials: LC
authors.lastname: Figueiredo
authors.affiliation: Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Faveri
authors.affiliation: Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil mferes@ung.br.
authors.forename: M
authors.initials: M
authors.lastname: Feres
mesh_terms: 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*; D018441:Biofilms / Q000187:drug effects; D003773:Dental Plaque / Q000150:complications / Q000188:drug therapy; D012534:Dental Scaling; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005881:Gingiva / Q000187:drug effects / Q000382:microbiology; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use*; D010518:Periodontitis / Q000150:complications / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D008795:Metronidazole; D000658:Amoxicillin
keywords: antibiotics; chronic periodontitis; microbiology; periodontal diseases; therapeutics; type 2 diabetes mellitus