Empirical or microbiologically-guided systemic antimicrobials as adjuncts to non-surgical periodontal therapy? a systematic review.

Abstract

BACKGROUND\nIt is unclear if patients with specific subgingival microbiological profiles benefit more from adjunctive systemic antibiotics.\n\n\nAIMS\nTo answer the question: What is the clinical benefit in periodontitis patients taking adjunctive systemic antimicrobials to non-surgical therapy, depending on pre-treatment detection of periodontopathogenic bacteria? \n\n\nMATERIALS AND METHODS\nA search was conducted in 4 electronic databases for randomised controlled trials reporting clinical outcomes following adjunctive antibiotic therapy for patients divided by baseline microbiological profiles.\n\n\nRESULTS\nThe initial search resulted in 643 papers, reduced to 5 after screening and author contact. Four of these studies were suitable for a fixed effects two-stage individual participant data meta-analysis adjusted for baseline data. Collectively, adjunctive Amoxicillin and Metronidazole yielded superior clinical results (measured as reduction of PPDs) compared to placebo. No significant differences were detected for the effect of adjunctive antibiotics by detection of A. actinomycetemcomitans on PPDs ≥ 5 mm (WMD=1.16, 95% CI[-5.37, 7.68], I2 =37.8%) or other clinical outcomes. All included studies had low risk of bias.\n\n\nCONCLUSION\nThere is no evidence to suggest that baseline detection of periodontopathogenic bacteria should be used as criterion for prescribing adjunctive antibiotics, although only limited information on microbial data and specific antimicrobials were available for analysis.