Effect of Systemically Administered Amoxicillin and Metronidazole in the Treatment of Chronic Periodontitis
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Keywords

Antinfective agents
amoxicillin
chronic periodontitis
metronidazole
nonsurgical periodontal therapy
therapeutic use

Abstract

Introduction: Nonsurgical periodontal therapy reduces periodontal inflammation, but complete removal of toxin and bacterial deposits is not always possible. Thus, adjunctive therapeutic strategies like use of systemic amoxicillin and metronidazole have evolved.

Objective: To evaluate effect of systemically administered amoxicillin and metronidazole in the treatment of chronic periodontitis.

Methods: A pretest post-test study was conducted from February 2021 to November 2021 in Department of Periodontics and Oral Implantology at Peoples Dental College and Hospital after ethical clearance from Institutional Review Committee of PDCH. Thirty-six patients with chronic periodontitis were recruited through convenient sampling. The patients were assigned into two groups meeting the criteria of at least six teeth with probing pocket depth 5-7 mm. Group A received scaling and root planing and Group B received adjunctive systemic Amoxicillin and Metronidazole three times daily for seven days. Clinical parameters were evaluated at one month, three months and six months post-treatment. Data were analysed in SPSS v.20.

Results: Mean values of pocket depth (PD), clinical attachment level (CAL), plaque index (PI) and gingival index (GI) were reduced significantly after treatment in both treatment groups with more clinical improvement in adjunctive systemic amoxicillin and metronidazole. However, on intergroup comparison, clinical attachment level and plaque index was not significantly reduced.

Conclusions: The findings of the current study showed significant improvements in both groups compared with baseline. Thus, adjunctive systemic amoxicillin and metronidazole provide better results than scaling root planing alone.

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References

American Academy of Periodontology, editor. In:Glossary of Periodontal terms 4th ed. Chicago,AAP; 2001:p40-6.
Genco RJ. Current View of Risk Factors for Periodontal Diseases. J Periodontol. 1996; 67:1041-9.
Grossi SG, Zambon JJ, Ho AW, Koch G, Dunford RG, Machtei EE, et al. Assessment of risk for periodontal disease. Risk indicators for attachment loss. J Periodontol. 1994;65(3):260-7.
Kornman KS, Crane A, Wang HY, Giovlne FSD, Newman MG, Pirk FW,et.al. The interleukin-1 genotype as a severity factor in adult periodontal disease. J Clin Periodontol. 1997;24(1):72-7.
Cobb CM. Clinical significance of non-surgical periodontal therapy: An evidence-based perspective of scaling and root planing. J Clin Periodontol. 2002;29(s2):22-32.
Okamoto T, Yoshiyama H, Nakazawa T, Park ID, Chang MW, Yanai H, et al. A change in PBP1 is involved in amoxicillin resistance of clinical isolates of helicobacter pylori. J Antimicrob Chemother. 2002;50(6):849-56.
K. D Tripathi, Textbook of essentials of medical pharmacology.6th ed. New Delhi,India, Jaypee Brothers Medical, 2008. Chapter 49, Antimicrobial Drugs; p667-81.
Van Winkelhoff A, Rodenburg J, Goené R, Abbas F, Winkel E, De Graaff J. Metronidazole plus amoxycillin in the treatment of Actinobacillus associated periodontitis. J Clin Periodontol. 1989;16(2):128-31.
Berglundh T, Krok L, Liljenberg B, Westfelt E, Serino G, Lindhe J. The use of metronidazole and amoxicillin in the treatment of advanced periodontal disease: A prospective, controlled clinical trial. J Clin Periodontol. 1998;25(5):354-62.
Christersson LA, Albini B, Zambon JJ, Wikesjo UM, Genco RJ. Tissue localization of Actinobacillus actinomycetemcomitans in human periodontitis. I. Light, immunofluorescence and electron microscopic studies. J Periodontol. 1987;58(8):529-39.
Herrera D, Sanz M, Jepsen S, Needleman I, Roldán S. A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients. J Clin Periodontol. 2002;29:136-59.
Haffajee AD, Socransky SS, Gunsolley JC. Systemic anti-infective periodontal therapy. A systematic review. Ann Periodontol. 2003;8(1):115-81.
Loesche W, Giordano J. Metronidazole in periodontitis V: debridement should precede medication. Compendium (Newton,Pa). 1994;15(10):5671-85.
López NJ, Gamonal JA, Martinez B. Repeated Metronidazole and Amoxicillin Treatment of Periodontitis. A Follow-Up Study. J Periodontol. 2000;71(1):79-89.
Winkel EG, Winkelhoff AJ Van, Timmerman MF, der Velden U Van, der Weijden GA Van. Amoxicillin plus metronidazole in the treatment of adult periodontitis patients:a double- blind placebo-controlled study. J Clin Periodontol. 2001;28(4):296-305.
Ehmke B, Moter A, Beikler T, Milian E, Flemmig TF. Adjunctive antimicrobial therapy of periodontitis: Long-term effects on disease progression and oral colonization. J Periodontol. 2005;76(5):749-59.
Rooney J, Wade WG, Sprague S, Newcombe RG, Addy M. Adjunctive effects to non-surgical periodontal therapy of systemic metronidazole and amoxycillin alone and combined: A placebo-controlled study. J Clin Periodontol. 2002;29(4):342-50.
18. Offenbacher S, Odle B, van Dyke T. The use of crevicular fluid prostaglandin E2 levels as a predictor of periodontal attachment loss. J Periodontal Res. 1986;21(2):101-12.
Ribeiro ÉDP, Bittencourt S, Zanin ICJ, Ambrosano GMB, Sallum EA, Nociti FH, et al. Full-mouth ultrasonic debridement associated with amoxicillin and metronidazole in the treatment of severe chronic periodontitis. J Periodontol. 2009;80(8):1254-64.
Slots J, Ting M. Systemic antibiotics in the treatment of periodontal disease. Periodontol 2000. 2002;28(1):106-71.
Silva MP, Feres M, Sirotto TA, Soares GMS, Mendes JAV, Faveri M, et al. Clinical and microbiological benefits of metronidazole alone or with amoxicillin as adjuncts in the treatment of chronic periodontitis: A randomized placebo-controlled clinical trial. J Clin Periodontol. 2011;38(9):828-37.
Teughels W, Feres M, Oud V, Martin C, Matesanz P, Herrera D. Adjunctive effect of systemic antimicrobials in periodontitis therapy: A systematic review and meta – analysis. J Clin Periodonotol. 2020; 47 (s22): 257-81.
Zhao H, Hu J, Zhao L. The effect of drug dose and duration of adjuvant Amoxicillin plus Metronidazole to full mouth scaling and root planning in periodontitis: A systematic review and meta- analysis. Clin Oral Investig. 2021; 25 (10): 5671-85.