Systemic amoxicillin and metronidazole effective in patients with generalized stage III and grade C periodontitis

In the present study, researchers assessed treatment response after systemic amoxicillin/metronidazole adjunctive to SI based on stages and grades of the 2018 classification of periodontal diseases.

The study could be summarised as follows:

• They re-analyzed the ABPARO trial in patients aged 45-60 years.
• The study had 205 males, and 114 were active smokers.
• Tota 200 Patients have been randomized to SI with systemic amoxicillin 500 mg/metronidazole 400 mg (three times a day for seven days, ANTI)
• A total of 200 patients were randomized to placebo or PLAC.
• Patients were reclassified based on the 2018 classification (stage/extent/grade).
• The treatment effect was the percentage of sites per patient with new attachment loss ≥1.3 mm (PSAL ≥ 1.3 mm) at 27.5 months post-baseline/randomization.
• Forty-nine patients had localized stage III periodontitis, 206 had generalized stage III and 150 had stage IV periodontitis.
• Radiographs were missing for only 222 patients.
• Treatment (PLAC/ANTI) resulted in PSAL ≥ 1.3 mm in localized stage III (PLAC: 5.7; 3.3/8.4% vs ANTI: 4.9; 3.0/8.3%), generalized stage III (8.0; 4.5/14.3% vs 4.7; 2.4/9.0%;), stage IV (8.5; 5.1/14.4% vs 5.7; 3.3/10.6%), grade B (4.4; 2.4/6.7% vs 3.6; 1.9/4.7%) and grade C (9.4; 5.3/14.3% vs 4.8; 2.5/9.4%).

They said, “In generalized periodontitis stage III/grade C, a clinically relevant lower percentage of disease progression after adjunctive systemic amoxicillin/metronidazole was observed compared to placebo.”

Explaining the Scientific rationale for the study, they said that “Systemic amoxicillin and metronidazole are established adjuncts for SI. Aggressive periodontitis, the baseline percentage of sites with a pocket probing depth ≥5 mm, and age are indicators for antimicrobial use before the 2018 classification of periodontal diseases publication. The 2018 classification's stage/extent/grade system may provide similar indications for the decision for or against adjunctive antimicrobials.”

We found a benefit for systemic amoxicillin and metronidazole adjunctive to SI over placebo in patients with generalized stage III and grade C periodontitis regarding less additional clinical attachment loss.

Further reading:

https://onlinelibrary.wiley.com/doi/full/10.1111/jcpe.13838