3-day Systemic Antibiotics with Subgingival Instrumentation good enough for aggressive Periodontitis

Recent research found that in aggressive periodontitis patients a 3-day systemic administration of Amoxicillin and Metronidazole along with subgingival instrumentation yielded good clinical outcomes after 6 months with fewer adverse events. The study was published in "Journal of Clinical Periodontology."

Periodontitis can cause severe functional and esthetic dysfunctions. It is a multifactorial disease caused due to disturbances in angiogenesis, microbiota, and inflammatory infiltrate. Instrumentation and antibiotics are the mainstays of treatment of periodontitis. Raluca et al conducted a study to evaluate the clinical non-inferiority of a 3-day-protocol of systemic antibiotics (SAB) adjunctive to subgingival instrumentation (SI) compared to a 7-day-protocol in patients with stage III/IV grade C periodontitis.

A randomized study was performed on 50 systemically healthy patients aged 32.7±4.3 years with aggressive periodontitis (stage III/IV grade C periodontitis). Subgingival Instrumentation along with adjunctive antibiotics (AB) like amoxicillin and metronidazole were given. Patients were assigned to two groups of 25 each randomly. Group A was given 500mg antibiotics 3-times-daily for 3 days, followed by a placebo 3-times-daily for 4 days, and group B was given 500mg antibiotics 3-times-daily for 7 days. Clinical, microbial, and immunological parameters were assessed at baseline, 3 and 6 months, and patient-related outcomes after 2 weeks. The number of residual sites with PD≥6mm at 6 months was the primary outcome variable.

Results:

• For the primary outcome variable, the null hypothesis was rejected and demonstrated the non-inferiority of the 3d AB protocol compared to 7d AB.
• Comparable clinical improvements were obtained for all parameters with both antibiotic protocols (p>0.05).
• Significant reduction of all investigated periodontopathogens and pro-inflammatory host-derived markers were observed, without differences between the treatments (p>0.05). 

Thus, researchers concluded that in patients with aggressive periodontitis (stage III/IV grade C periodontitis), the clinical outcomes of a 3-day administration of systemic amoxicillin and metronidazole adjunctive to SI were non-inferior to a 7-day-protocol after 6-months.  

To read the full article, click here:  https://doi.org/10.1111/jcpe.13676 

Cosgarea R, Jepsen S, Heumann C, et al. Clinical, microbiological and immunological effects of 3- or 7-day systemic antibiotics adjunctive to subgingival instrumentation in patients with aggressive (stage III/IV grade C) periodontitis: a randomized placebo-controlled clinical trial [published online ahead of print, 2022 Jul 4]. J Clin Periodontol. 2022;10.1111/jcpe.13676.