The Use of Amoxicillin (500mg) Plus Metronidazole (500mg) For 7 Days Adds Adjunctive Benefits For Non-Surgical Periodontal Therapy, But Limited Evidence Supports Higher/Longer Dose

Journal of Evidence Based Dental Practice

Available online 22 June 2018

In Press, Accepted Manuscript — Note to users

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Summary

Selection Criteria:

The search was conducted through the electronic database of Embase and MEDLINE (via OvidSP) from 1946 to April 2017 for randomized clinical trials on different combinations and modifications of the key words, including periodontitis, amoxicillin, metronidazole, and randomized controlled clinical trial. The Cochrane Central Register and the WHO International Clinical Trials Registry Platform were also searched for relevant clinical trials. The reference lists of all included studies and relevant reviews were manually cross-referenced to ensure comprehensive data collection. Two reviewers conducted the screening, quality assessment, and selection of the articles.

Key Study Factor

The key study factor (intervention) was blinded, randomized placebo-controlled trials with nonsurgical periodontal therapy and adjunctive consumption of amoxicillin and metronidazole. However, there is heterogeneity of the length and dose of the antibiotics prescribed.

Main Outcome Measure

The primary outcomes assessed were periodontal pocket probing depth and clinical attachment level 3 months after a combination of nonsurgical periodontal therapy and use of the systematic antibiotics amoxicillin and metronidazole.

Main Results

Out of the 376 records identified, 18 studies were included for qualitative synthesis and 15 studies included for quantitative analysis. Meta-analysis showed a small beneficial effect of adjunctive amoxicillin plus metronidazole for an additional mean weighted pocket depth reduction of 0.36-0.38 mm. No clinically significant difference was found among the various doses and durations for the medication use.

Conclusions

Based on the studies reviewed, no recommendations for the optimal duration of the antibiotic course can be given. However, based on the principles of responsible antibiotics use, the highest dose with the shortest duration of time is recommended to reduce the risk of antibiotic resistance. Therefore, a 7-day regimen of 500/500 mg or 500/400 mg of amoxicillin and metronidazole would be most appropriate.