Metronidazole alone or with amoxicillin as adjuncts to non-surgical treatment of chronic periodontitis: a secondary analysis of microbiological results from a randomized clinical trial
Aim To evaluate the changes occurring in the subgingival microbial profile of subjects with generalized chronic periodontitis (ChP) treated by scaling and root planing (SRP) alone or with metronidazole (MTZ) or MTZ + amoxicillin (AMX). A secondary aim was to examine a possible added effect of chlorh...
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| Published in | Journal of clinical periodontology Vol. 41; no. 4; pp. 366 - 376 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Blackwell Publishing Ltd
01.04.2014
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| Subjects | |
| Online Access | Get full text |
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| Abstract | Aim
To evaluate the changes occurring in the subgingival microbial profile of subjects with generalized chronic periodontitis (ChP) treated by scaling and root planing (SRP) alone or with metronidazole (MTZ) or MTZ + amoxicillin (AMX). A secondary aim was to examine a possible added effect of chlorhexidine (CHX) to these therapies.
Methods
One hundred and eighteen subjects were randomly assigned to receive SRP‐only or with MTZ [400 mg/thrice a day (TID)] or MTZ + AMX (500 mg/TID) for 14 days. Half of the subjects in each group rinsed with 0.12% CHX twice a day (BID) for 2 months. Nine subgingival plaque samples/subject were analysed by checkerboard DNA–DNA hybridization for 40 bacterial species at baseline, 3, 6 and 12 months post‐therapy.
Results
At 12 months, the antibiotic‐treated groups harboured lower mean counts and proportions of key periodontal pathogens than the SRP group (p < 0.05). These benefits were observed at initially deep and shallow sites. Initial reductions in periodontal pathogens obtained with SRP partially rebound after 12 months. CHX rinsing enhanced the microbiological effects of the MTZ + AMX treatment in shallow sites.
Conclusion
The adjunctive use of MTZ and MTZ + AMX results in a greater reduction in the levels of periodontal pathogens in generalized ChP subjects compared to SRP alone. |
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| AbstractList | To evaluate the changes occurring in the subgingival microbial profile of subjects with generalized chronic periodontitis (ChP) treated by scaling and root planing (SRP) alone or with metronidazole (MTZ) or MTZ + amoxicillin(AMX). A secondary aim was to examine a possible added effect of chlorhexidine(CHX) to these therapies.AIMTo evaluate the changes occurring in the subgingival microbial profile of subjects with generalized chronic periodontitis (ChP) treated by scaling and root planing (SRP) alone or with metronidazole (MTZ) or MTZ + amoxicillin(AMX). A secondary aim was to examine a possible added effect of chlorhexidine(CHX) to these therapies.One hundred and eighteen subjects were randomly assigned to receive SRP-only or with MTZ [400 mg/thrice a day (TID)] or MTZ + AMX (500 mg/TID) for 14 days. Half of the subjects in each group rinsed with 0.12% CHX twice a day (BID) for 2 months. Nine subgingival plaque samples/subject were analysed by checkerboard DNA–DNA hybridization for 40 bacterial species at baseline, 3, 6 and 12 months post-therapy.METHODSOne hundred and eighteen subjects were randomly assigned to receive SRP-only or with MTZ [400 mg/thrice a day (TID)] or MTZ + AMX (500 mg/TID) for 14 days. Half of the subjects in each group rinsed with 0.12% CHX twice a day (BID) for 2 months. Nine subgingival plaque samples/subject were analysed by checkerboard DNA–DNA hybridization for 40 bacterial species at baseline, 3, 6 and 12 months post-therapy.At 12 months, the antibiotic-treated groups harboured lower mean counts and proportions of key periodontal pathogens than the SRP group (p < 0.05). These benefits were observed at initially deep and shallow sites. Initial reductions in periodontal pathogens obtained with SRP partially rebound after 12 months. CHX rinsing enhanced the microbiological effects of the MTZ + AMX treatment in shallow sites.RESULTSAt 12 months, the antibiotic-treated groups harboured lower mean counts and proportions of key periodontal pathogens than the SRP group (p < 0.05). These benefits were observed at initially deep and shallow sites. Initial reductions in periodontal pathogens obtained with SRP partially rebound after 12 months. CHX rinsing enhanced the microbiological effects of the MTZ + AMX treatment in shallow sites.The adjunctive use of MTZ and MTZ + AMX results in a greater reduction in the levels of periodontal pathogens in generalized ChP subjects compared to SRP alone.CONCLUSIONThe adjunctive use of MTZ and MTZ + AMX results in a greater reduction in the levels of periodontal pathogens in generalized ChP subjects compared to SRP alone. Aim To evaluate the changes occurring in the subgingival microbial profile of subjects with generalized chronic periodontitis (ChP) treated by scaling and root planing (SRP) alone or with metronidazole (MTZ) or MTZ + amoxicillin (AMX). A secondary aim was to examine a possible added effect of chlorhexidine (CHX) to these therapies. Methods One hundred and eighteen subjects were randomly assigned to receive SRP‐only or with MTZ [400 mg/thrice a day (TID)] or MTZ + AMX (500 mg/TID) for 14 days. Half of the subjects in each group rinsed with 0.12% CHX twice a day (BID) for 2 months. Nine subgingival plaque samples/subject were analysed by checkerboard DNA–DNA hybridization for 40 bacterial species at baseline, 3, 6 and 12 months post‐therapy. Results At 12 months, the antibiotic‐treated groups harboured lower mean counts and proportions of key periodontal pathogens than the SRP group (p < 0.05). These benefits were observed at initially deep and shallow sites. Initial reductions in periodontal pathogens obtained with SRP partially rebound after 12 months. CHX rinsing enhanced the microbiological effects of the MTZ + AMX treatment in shallow sites. Conclusion The adjunctive use of MTZ and MTZ + AMX results in a greater reduction in the levels of periodontal pathogens in generalized ChP subjects compared to SRP alone. To evaluate the changes occurring in the subgingival microbial profile of subjects with generalized chronic periodontitis (ChP) treated by scaling and root planing (SRP) alone or with metronidazole (MTZ) or MTZ + amoxicillin(AMX). A secondary aim was to examine a possible added effect of chlorhexidine(CHX) to these therapies. One hundred and eighteen subjects were randomly assigned to receive SRP-only or with MTZ [400 mg/thrice a day (TID)] or MTZ + AMX (500 mg/TID) for 14 days. Half of the subjects in each group rinsed with 0.12% CHX twice a day (BID) for 2 months. Nine subgingival plaque samples/subject were analysed by checkerboard DNA–DNA hybridization for 40 bacterial species at baseline, 3, 6 and 12 months post-therapy. At 12 months, the antibiotic-treated groups harboured lower mean counts and proportions of key periodontal pathogens than the SRP group (p < 0.05). These benefits were observed at initially deep and shallow sites. Initial reductions in periodontal pathogens obtained with SRP partially rebound after 12 months. CHX rinsing enhanced the microbiological effects of the MTZ + AMX treatment in shallow sites. The adjunctive use of MTZ and MTZ + AMX results in a greater reduction in the levels of periodontal pathogens in generalized ChP subjects compared to SRP alone. Aim To evaluate the changes occurring in the subgingival microbial profile of subjects with generalized chronic periodontitis (ChP) treated by scaling and root planing (SRP) alone or with metronidazole (MTZ) or MTZ + amoxicillin (AMX). A secondary aim was to examine a possible added effect of chlorhexidine (CHX) to these therapies. Methods One hundred and eighteen subjects were randomly assigned to receive SRP-only or with MTZ [400 mg/thrice a day (TID)] or MTZ + AMX (500 mg/TID) for 14 days. Half of the subjects in each group rinsed with 0.12% CHX twice a day (BID) for 2 months. Nine subgingival plaque samples/subject were analysed by checkerboard DNA-DNA hybridization for 40 bacterial species at baseline, 3, 6 and 12 months post-therapy. Results At 12 months, the antibiotic-treated groups harboured lower mean counts and proportions of key periodontal pathogens than the SRP group (p < 0.05). These benefits were observed at initially deep and shallow sites. Initial reductions in periodontal pathogens obtained with SRP partially rebound after 12 months. CHX rinsing enhanced the microbiological effects of the MTZ + AMX treatment in shallow sites. Conclusion The adjunctive use of MTZ and MTZ + AMX results in a greater reduction in the levels of periodontal pathogens in generalized ChP subjects compared to SRP alone. [PUBLICATION ABSTRACT] |
| Author | Soares, Geisla M. S. Faveri, Marcelo Wang, Xiaoshan Figueiredo, Luciene C. Mendes, Juliana A. V. Socransky, Sigmund S. Feres, Magda Silva, Maike P. Teles, Ricardo |
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| Copyright | 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Copyright © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd |
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| Notes | istex:DFDA9CACAA8C1CF8FFDECDD95D73B84B65D406FD Fig S1. Flow chart of the study design (Feres et al. JCP, ). SRP, scaling and root planing; MTZ, metronidazole; AMX, amoxicillin; CHX chlorhexidine.Table S1. Mean counts (×105) of 40 subgingival species at baseline, 3, 6 and 12 months post-therapy in each treatment group. Calculated least square means values for the follow-up visits were computed using generalized estimating equation adjusting for baseline values. The significance of differences among groups at each post-therapy time point was assessed using T-test with adjusted degrees of freedom. The Benjamini and Yekutieli approach to control for false discovery rate (FDR) in multiple comparisons was employed. SRP; scaling and root planing; MTZ, metronidazole; AMX, amoxicillin; Std. Err., Standard Error of the Mean. Table S2. Mean percentage of DNA probe count of 40 subgingival species at baseline, 3, 6 and 12 months post-therapy in each treatment group. Calculated least square means values for the follow-up visits were computed using generalized estimating equation adjusting for baseline values. The significance of differences among groups at each post-therapy time point was assessed using T-test with adjusted degrees of freedom. The Benjamini and Yekutieli approach to control for false discovery rate (FDR) in multiple comparisons was employed. SRP; scaling and root planing; MTZ, metronidazole; AMX, amoxicillin; Std. Err., Standard Error of the Mean. Table S3a,b. Mean counts (×105) of 40 subgingival species at baseline, 3, 6 and 12 months post-therapy in each treatment group subset into shallow (S3a) (PD ≤4 mm) and deep (S3b) (PD ≥5 mm) sites. Calculated least square means values for the follow-up visits were computed using generalized estimating equation adjusting for baseline values. The significance of differences among groups at each post-therapy time point was assessed using T-test with adjusted degrees of freedom. The Benjamini and Yekutieli approach to control for false discovery rate (FDR) in multiple comparisons was employed. MTZ, metronidazole; AMX, amoxicillin. ark:/67375/WNG-L0T6HM6N-J Fundação de Amparo à Pesquisa do Estado de São Paulo - No. 07/55291-9 ArticleID:JCPE12217 The authors declare that they have no conflict of interests. his study was supported by Research Grant #07/55291‐9 from Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, Brazil). Conflict of interest and sources of funding statement ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 14 content type line 23 ObjectType-Undefined-3 |
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R., Haerian-ardakani, A., Zandi, H., Taghipour, S., Fallahzadeh, H., Pakzad, A. & Fahami, N. (2007) Adjunctive effects of systemic amoxicillin and metronidazole with scaling and root planing: a randomized, placebo controlled clinical trial. The Journal of Contemporary Dental Practice 1, 51-59. Sgolastra, F., Gatto, R., Petrucci, A. & Monaco, A. (2012b) Effectiveness of systemic amoxicillin/metronidazole as adjunctive therapy to scaling and root planing in the treatment of chronic periodontitis: a systematic review and meta-analysis. Journal of Periodontology 83, 1257-1269. Winkel, E. G., van Winkelhoff, A. J., Timmerman, M. F., van der Velden, U. & van der Weijden, G. A. (2001) Amoxicillin plus metronidazole in the treatment of adult periodontitis patients. A double-blind placebo controlled study. 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To evaluate the changes occurring in the subgingival microbial profile of subjects with generalized chronic periodontitis (ChP) treated by scaling and root... To evaluate the changes occurring in the subgingival microbial profile of subjects with generalized chronic periodontitis (ChP) treated by scaling and root... Aim To evaluate the changes occurring in the subgingival microbial profile of subjects with generalized chronic periodontitis (ChP) treated by scaling and root... |
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| Title | Metronidazole alone or with amoxicillin as adjuncts to non-surgical treatment of chronic periodontitis: a secondary analysis of microbiological results from a randomized clinical trial |
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