Administration of systemic antibiotics during non-surgical periodontal therapy—a consensus report
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.
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.
KeywordsPeriodontal 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.
- 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.Jordan, R. M., Wolfgang (2016) 5.Deutsche Mundgesundheitsstudie. https://www.bzaek.de/fileadmin/PDFs/dms/Zusammenfassung_DMS_V.pdf.
- 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
- 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
- 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.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
- 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.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
- 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.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.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
- 45.de With S-LdDGfrIeVD. S3-Leitlinie “Strategien zur Sicherung rationale Antibiotika-Anwendung im Krankenhaus” (092/001) https://www.awmf.org/uploads/tx_szleitlinien/092-001l_S3_Antibiotika_Anwendung_im_Krankenhaus_2013-verlaengert.pdf
- 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