Administration of systemic antibiotics during non-surgical periodontal therapy—a consensus report

  • B. PretzlEmail author
  • S. Sälzer
  • B Ehmke
  • U. Schlagenhauf
  • B. Dannewitz
  • H. Dommisch
  • P. Eickholz
  • Y. Jockel-Schneider
Original Article



The aim of this meta-review was to evaluate whether there is a meaningful clinical benefit regarding the use of systemic adjunctive antibiotics in the treatment of patients with periodontitis. Additionally, a consensus regarding possible recommendations for future administration of antibiotics should be reached.


A structured literature search was performed by two independent investigators focusing on systematic reviews (SR) covering adjunctive systemic antibiosis during non-surgical periodontal therapy. Additionally, recent randomized clinical trials (RCT, July 2015 to July 2017) were searched systematically to update the latest SR. Results were summarized and discussed in a plenary to reach a consensus.


Mostly, systematic reviews and RCTs showed a significant positive effect of adjunctive systematic antibiosis compared to controls. These positive effects gain clinical relevance in patients with severe periodontal disease aged 55 years and younger.


Systemic antibiotics as an adjunct to non-surgical periodontal therapy should be sensibly administered and restrictively used. Only certain groups of periodontitis patients show a significant and clinically relevant benefit after intake of systemic antibiosis during periodontal therapy.

Clinical relevance

Avoiding antibiotic resistance and possible side effects on the human microbiome should be a focus of dentists and physicians. Thus, a sensible administration of antibiotics is mandatory. This manuscript suggests guidelines for a reasonable use.


Periodontal therapy Antibiotic Adjunctive systemic antibiosis Non-surgical therapy 



The authors thank Dr. Samir Abou-Ayash (DGI), Prof. Dr. Ralf Bürgers (DG PRO), Dr. Thomas Eger (AKPP), Prof. Dr. Stefan Frantz (DGK), Dr. Dr. Ralf Kettner (DGMKG), Dr. Stefan Liepe (BDIZ EDI), Priv.-Doz. Dr. Annette Moter (DGHM), Prof. Dr. Rainer Müller (DG HNO-KHC), Dr. Silke Riemer (BZÖG), Prof. Dr. Stefan Rupf (DGZ), Marion Schellmann (VMF Referat Zahnmedizinische Fachangestellte), Frau Tugce Schmitt (KZBV), and Priv.-Doz. Dr. Dirk Ziebolz, M.Sc. (DGZ).


This study was partially funded by a grant of the DG PARO and AWMF research fund, and for Yvonne Jockel-Schneider, a grant of the Commission for Young Scientists and Gender Equality, University of Wuerzburg (2.2-220.522-97/15_1) and the IZKF (2.2-220.522-97/2015_1).

The consensus conference was planned, organized, and financed by DG PARO®. In addition, the consensus task force of the German Society for Dental and Oral Medicine (DGZMK), Federal Dental Association (BZÄK), and German corporation of public dentists (KZBV) contributed to the financing. Thus, the consensus paper could be established in editorial independence.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval


Informed consent


Supplementary material

784_2018_2727_MOESM1_ESM.docx (14 kb)
ESM 1 (DOCX 14 kb)
784_2018_2727_MOESM2_ESM.docx (29 kb)
ESM 2 (DOCX 29 kb)


  1. 1.
    Kassebaum NJ, Bernabe E, Dahiya M, Bhandari B, Murray CJ, Marcenes W (2014) Global burden of severe periodontitis in 1990-2010: a systematic review and meta-regression. J Dent Res 93:1045–1053CrossRefPubMedGoogle Scholar
  2. 2.
    Eickholz P (2013) Was ist eigentlich eine PZR? Und welche Bedeutung hat die PZR im Rahmen der Unterstützenden Parodontitistherapie (UPT). Parodontologie 24:255–263Google Scholar
  3. 3.
    Jordan, R. M., Wolfgang (2016) 5.Deutsche Mundgesundheitsstudie.
  4. 4.
    Flemmig TF (1999) Periodontitis. Ann Periodontol 4:32–38CrossRefPubMedGoogle Scholar
  5. 5.
    Haag DG, Peres KG, Balasubramanian M, Brennan DS (2017) Oral conditions and health-related quality of life: a systematic review. J Dent Res 96(8):864–874CrossRefPubMedGoogle Scholar
  6. 6.
    Roumanas ED (2009) The social solution-denture esthetics, phonetics, and function. J Prosthodont 18:112–115CrossRefPubMedGoogle Scholar
  7. 7.
    Loos BG (2005) Systemic markers of inflammation in periodontitis. J Periodontol 76:2106–2115. CrossRefGoogle Scholar
  8. 8.
    Deschner J, Haak T, Jepsen S, Kocher T, Mehnert H, Meyle J, Schumm-Draeger PM, Tschope D (2011) Diabetes mellitus and periodontitis. Bidirectional relationship and clinical implications. A consensus document. Internist (Berl) 52:466–477CrossRefGoogle Scholar
  9. 9.
    Lalla E, Papapanou PN (2011) Diabetes mellitus and periodontitis: a tale of two common interrelated diseases. Nat Rev Endocrinol 7:738–748CrossRefPubMedGoogle Scholar
  10. 10.
    Dietrich T, Sharma P, Walter C, Weston P, Beck J (2013) The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J Periodontol 84:70–84CrossRefGoogle Scholar
  11. 11.
    Lockhart PB, Bolger AF, Papapanou PN, Osinbowale O, Trevisan M, Levison ME, Taubert KA, Newburger JW, Gornik HL, Gewitz MH, Wilson WR, Smith SC Jr, Baddour LM, American Heart Association Rheumatic Fever, E., Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, C. o. E., Prevention, C. o. P. V. D. & Council on Clinical, C (2012) Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?: a scientific statement from the American Heart Association. Circulation 125:2520–2544CrossRefPubMedGoogle Scholar
  12. 12.
    Usher AK, Stockley RA (2013) The link between chronic periodontitis and COPD: a common role for the neutrophil? BMC Med 11:241CrossRefPubMedGoogle Scholar
  13. 13.
    Kaur S, White S, Bartold PM (2013) Periodontal disease and rheumatoid arthritis: a systematic review. J Dent Res 92:399–408CrossRefPubMedGoogle Scholar
  14. 14.
    Kaur S, Bright R, Proudman SM, Bartold PM (2014) Does periodontal treatment influence clinical and biochemical measures for rheumatoid arthritis? A systematic review and meta-analysis. Semin Arthritis Rheum 44:113–122CrossRefPubMedGoogle Scholar
  15. 15.
    Hajishengallis G (2015) Periodontitis: from microbial immune subversion to systemic inflammation. Nat Rev Immunol 15:30–44CrossRefPubMedGoogle Scholar
  16. 16.
    Tonetti MS, Eickholz P, Loos BG, Papapanou P, van der Velden U, Armitage G, Bouchard P, Deinzer R, Dietrich T, Hughes F, Kocher T, Lang NP, Lopez R, Needleman I, Newton T, Nibali L, Pretzl B, Ramseier C, Sanz-Sanchez I, Schlagenhauf U, Suvan JE (2015) Principles in prevention of periodontal diseases: consensus report of group 1 of the 11th European Workshop on Periodontology on effective prevention of periodontal and peri-implant diseases. J Clin Periodontol 42 Suppl 16:S5–S11Google Scholar
  17. 17.
  18. 18.
    Nesse W, Abbas F, van der Ploeg I, Spijkervet FK, Dijkstra PU, Vissink A (2008) Periodontal inflamed surface area: quantifying inflammatory burden. J Clin Periodontol 35:668–673CrossRefPubMedGoogle Scholar
  19. 19.
    Ahuja A, Baiju CS, Ahuja V (2012) Role of antibiotics in generalized aggressive periodontitis: a review of clinical trials in humans. J Indian Soc Periodontol 16(3):317–323CrossRefPubMedGoogle Scholar
  20. 20.
    Assem NZ, Alves MLF, Lopes AB, Gualberto EC Jr, Garcia VG, Theodoro LH (2017) Antibiotic therapy as an adjunct to scaling and root planing in smokers: a systematic review and meta-analysis. Braz Oral Res 31:e67CrossRefPubMedGoogle Scholar
  21. 21.
    Buset SL, Zitzmann NU, Weiger R, Walter C (2015) Non-surgical periodontal therapy supplemented with systemically administered azithromycin: a systematic review of RCTs. Clin Oral Investig 19:1763–1775CrossRefPubMedGoogle Scholar
  22. 22.
    Chambrone L, Vargas M, Arboleda S, Serna M, Guerrero M, de Sousa J, Lafaurie GI (2016) Efficacy of local and systemic antimicrobials in the non-surgical treatment of smokers with chronic periodontitis: a systematic review. J Periodontol 87(11):1320–1332CrossRefPubMedGoogle Scholar
  23. 23.
    Garcia Canas P, Khouly I, Sanz J, Loomer PM (2015) Effectiveness of systemic antimicrobial therapy in combination with scaling and root planing in the treatment of periodontitis: a systematic review. J Am Dent Assoc 146:150–163CrossRefPubMedGoogle Scholar
  24. 24.
    Grellmann AP, Sfreddo CS, Maier J, Lenzi TL, Zanatta FB (2016) Systemic antimicrobials adjuvant to periodontal therapy in diabetic subjects: a meta-analysis. J Clin Periodontol 43(3):250–260CrossRefPubMedGoogle Scholar
  25. 25.
    Haffajee AD, Socransky SS, Gunsolley JC (2003) Systemic anti-infective periodontal therapy. A systematic review. Ann Periodontol 8(1):115–181CrossRefPubMedGoogle Scholar
  26. 26.
    Herrera D, Sanz M, Jepsen S, Needleman I, Roldán A (2002) A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients. J Clin Periodontol 29(Suppl 3):136–159 discussion 160-2CrossRefPubMedGoogle Scholar
  27. 27.
    Keestra JA, Grosjean I, Coucke W, Quirynen M, Teughels W (2015) Non-surgical periodontal therapy with systemic antibiotics in patients with untreated chronic periodontitis: a systematic review and meta-analysis. J Periodontal Res 50(3):294–314CrossRefPubMedGoogle Scholar
  28. 28.
    Keestra JA, Grosjean I, Coucke W, Quirynen M, Teughels W (2015) Non-surgical periodontal therapy with systemic antibiotics in patients with untreated aggressive periodontitis: a systematic review and meta-analysis. J Periodontal Res 50:689–706CrossRefPubMedGoogle Scholar
  29. 29.
    Kolakovic M, Held U, Schmidlin PR, Sahrmann P (2014 Dec 22) An estimate of pocket closure and avoided needs of surgery after scaling and root planing with systemic antibiotics: a systematic review. BMC Oral Health 14:159CrossRefPubMedGoogle Scholar
  30. 30.
    Rabelo CC, Feres M, Goncalves C, Figueiredo LC, Faveri M, Tu YK, Chambrone L (2015) Systemic antibiotics in the treatment of aggressive periodontitis. A systematic review and a Bayesian network meta-analysis. J Clin Periodontol 42:647–657CrossRefPubMedGoogle Scholar
  31. 31.
    Renatus A, Herrmann J, Schönfelder A, Schwarzenberger F, Jentsch H (2016) Clinical efficacy of azithromycin as an adjunctive therapy to non-surgical periodontal treatment of periodontitis: a systematic review and meta-analysis. J Clin Diagn Res 10(7):ZE01–ZE07PubMedGoogle Scholar
  32. 32.
    Santos CM, Lira-Junior R, Fischer RG, Santos AP, Oliveira BH (2015) Systemic antibiotics in periodontal treatment of diabetic patients: a systematic review. PLoS One 10(12):e0145262. eCollection 2015CrossRefPubMedGoogle Scholar
  33. 33.
    Sgolastra F, Gatto R, Petrucci A, Monaco A (2012) Effectiveness of systemic amoxicillin/metronidazole as adjunctive therapy to scaling and root planing in the treatment of chronic periodontitis: a systematic review and meta-analysis. J Periodontol 83:1257–1269CrossRefPubMedGoogle Scholar
  34. 34.
    Sgolastra F, Petrucci A, Gatto R, Monaco A (2012) Effectiveness of systemic amoxicillin/metronidazole as an adjunctive therapy to full-mouth scaling and root planing in the treatment of aggressive periodontitis: a systematic review and meta-analysis. J Periodontol 83:731–743CrossRefPubMedGoogle Scholar
  35. 35.
    Smiley CJ, Tracy SL, Abt E, Michalowicz BS, John MT, Gunsolley J, Cobb CM, Rossmann J, Harrel SK, Forrest JL, Hujoel PP, Noraian KW, Greenwell H, Frantsve-Hawley J, Estrich C, Hanson N (2015) Systematic review and meta-analysis on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. J Am Dent Assoc 146:508–524 e505CrossRefPubMedGoogle Scholar
  36. 36.
    Zandbergen D, Slot DE, Niederman R, Van der Weijden FA (2016) The concomitant administration of systemic amoxicillin and metronidazole compared to scaling and root planing alone in treating periodontitis: a systematic review. BMC Oral Health 29(16):27CrossRefGoogle Scholar
  37. 37.
    Ardila CM, Guzman IC (2015) Clinical factors influencing the efficacy of systemic moxifloxacin in the therapy of patients with generalized aggressive periodontitis: a multilevel analysis from a clinical trial. Glob J Health Sci 8:80–88CrossRefPubMedGoogle Scholar
  38. 38.
    Harks I, Koch R, Eickholz P, Hoffmann T, Kim TS, Kocher T, Meyle J, Kaner D, Schlagenhauf U, Doering S, Holtfreter B, Gravemeier M, Harmsen D, Ehmke B (2015) Is progression of periodontitis relevantly influenced by systemic antibiotics? A clinical randomized trial. J Clin Periodontol 42:832–842CrossRefPubMedGoogle Scholar
  39. 39.
    Martande SS, Pradeep AR, Kumari M, Priyanka N, Singh SP, Naik SB, Patel SP, Bagchi P (2015) Clinical and microbiological efficacy of systemic roxithromycin as an adjunct to non-surgical periodontal therapy in treatment of chronic periodontitis. A randomized, double-blinded, placebo-controlled clinical trial. Am J Dent 28(3):137–142PubMedGoogle Scholar
  40. 40.
    Pradeep AR, Singh SP, Martande SS, Naik SB, Priyanka N, Kalra N, Suke DK (2015) Clinical and microbiological effects of levofloxacin in the treatment of chronic periodontitis: a randomized, placebo-controlled clinical trial. J Investig Clin Dent 6(3):170–178CrossRefPubMedGoogle Scholar
  41. 41.
    Rebelatto Bechara Andere NM, Castro Dos Santos NC, Araujo CF, Mathias IF, Taiete T, Casarin RCV, Neves Jardini MA, Shaddox LM, Santamaria MP (2017) Clarithromycin as an adjunct to one-stage full mouth ultrasonic periodontal debridement in generalized aggressive periodontitis: a randomized controlled clinical trial. J Periodontol 88:1–15CrossRefGoogle Scholar
  42. 42.
    Taiete T, Casarin RC, Casati MZ, del Peloso Ribeiro E, Sallum EA, Nociti FH Jr (2016) Amoxicillin/metronidazole associated with nonsurgical therapy did not promote additional benefits in immunologic parameters in generalized aggressive periodontitis: a randomized controlled clinical trial. Quintessence Int 47:281–292PubMedGoogle Scholar
  43. 43.
    Caton J, Armitage G, Berglundh T et al (2018) A new classification scheme for periodontal and periimplant diseases and conditions—introduction and key changes from the 1999 classification. J Clin Periodontol 45(Suppl 20):S1–S8Google Scholar
  44. 44.
    Sedlacek MJ, Walker C (2007) Antibiotic resistance in an in vitro subgingival biofilm model. Oral Microbiol Immunol 22:333–339CrossRefPubMedGoogle Scholar
  45. 45.
    de With S-LdDGfrIeVD. S3-Leitlinie “Strategien zur Sicherung rationale Antibiotika-Anwendung im Krankenhaus” (092/001)
  46. 46.
    Dewhirst FE, Chen T, Izard J, Paster BJ, Tanner AC, Yu WH, Lakshmanan A, Wade WG (2010) The human oral microbiome. J Bacteriol 192:5002–5017CrossRefPubMedGoogle Scholar
  47. 47.
    Riep B, Edesi-Neuss L, Claessen F, Skarabis H, Ehmke B, Flemmig TF, Bernimoulin JP, Gobel UB, Moter A (2009) Are putative periodontal pathogens reliable diagnostic markers? J Clin Microbiol 47:1705–1711CrossRefPubMedGoogle Scholar
  48. 48.
    Mombelli A, Cionca N, Almaghlouth A, Decaillet F, Courvoisier DS, Giannopoulou C (2013) Are there specific benefits of amoxicillin plus metronidazole in aggregatibacter actinomycetemcomitans-associated periodontitis? Double-masked, randomized clinical trial of efficacy and safety. J Periodontol 84:715–724CrossRefPubMedGoogle Scholar
  49. 49.
    Cionca N, Giannopoulou C, Ugolotti G, Mombelli A (2010) Microbiologic testing and outcomes of full-mouth scaling and root planing with or without amoxicillin/metronidazole in chronic periodontitis. J Periodontol 81:15–23CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Conservative Dentistry, Section of Periodontology, Clinic for Oral, Dental and Maxillofacial DiseasesUniversity Hospital HeidelbergHeidelbergGermany
  2. 2.Clinic for Conservative Dentistry and PeriodontologyUniversity Hospital of Schleswig-HolsteinKielGermany
  3. 3.Department of PeriodontologyUniversity Hospital MünsterMünsterGermany
  4. 4.Divison of PeriodontologyUniversity Hospital of Julius-Maximilians-UniversityWürzburgGermany
  5. 5.Department of Periodontology, Center of Dentistry and Oral Medicine (Carolinum)Johann Wolfgang Goethe-University Frankfurt/MainFrankfurtGermany
  6. 6.Department of Periodontology and Synoptic DentistryCharité - Universitätsmedizin BerlinBerlinGermany

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