Luigi Nibali1,2, Vasiliki P Koidou1, Thomas Hamborg3, Nikos Donos1. 1. Centre for Oral Immunobiology and Regenerative Medicine and Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University London (QMUL), London, UK. 2. Periodontology Unit, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK. 3. Pragmatic Clinical Trials Unit, Queen Mary University London (QMUL), London, UK.
Abstract
BACKGROUND: It is unclear whether patients with specific subgingival microbiological profiles benefit more from adjunctive systemic antibiotics. AIMS: To 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?" MATERIALS AND METHODS: A search was conducted in four electronic databases for randomized controlled trials reporting clinical outcomes following adjunctive antibiotic therapy for patients divided by baseline microbiological profiles. RESULTS: The initial search resulted in 643 papers, reduced to five 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 the detection of Aggregatibacter 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. CONCLUSION: There 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 was available for analysis.
BACKGROUND: It is unclear whether patients with specific subgingival microbiological profiles benefit more from adjunctive systemic antibiotics. AIMS: To 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?" MATERIALS AND METHODS: A search was conducted in four electronic databases for randomized controlled trials reporting clinical outcomes following adjunctive antibiotic therapy for patients divided by baseline microbiological profiles. RESULTS: The initial search resulted in 643 papers, reduced to five 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 the detection of Aggregatibacter 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. CONCLUSION: There 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 was available for analysis.
Authors: Brooks A Swanson; Matthew D Carson; Jessica D Hathaway-Schrader; Amy J Warner; Joy E Kirkpatrick; Alexa Corker; Alexander V Alekseyenko; Caroline Westwater; J Ignacio Aguirre; Chad M Novince Journal: FASEB J Date: 2021-11 Impact factor: 5.191
Authors: Raluca Cosgarea; S Eick; S Jepsen; N B Arweiler; R Juncar; R Tristiu; G E Salvi; C Heumann; A Sculean Journal: Sci Rep Date: 2020-10-01 Impact factor: 4.379