Adjunctive benefits of systemic amoxicillin and metronidazole in non‐surgical treatment of generalized aggressive periodontitis: a randomized placebo‐controlled clinical trial

Abstract

Background: The objective of this study was to assess the adjunctive clinical effect of the administration of systemic amoxicillin and metronidazole in the non‐surgical treatment of generalized aggressive periodontitis (GAP). Methods: Forty‐one systemically healthy subjects with GAP were included in this 6‐month double‐blind, placebo‐controlled, randomized clinical trial. Patients received a course of full‐mouth non‐surgical periodontal treatment delivered over a 24 h period using machine‐driven and hand instruments. Test subjects received an adjunctive course of systemic antibiotic consisting of 500 mg amoxicillin and 500 mg metronidazole three times a day for 7 days. Clinical parameters were collected at baseline, and at 2 and 6 months post‐treatment. Results: In both the test and the placebo groups, all clinical parameters improved at 2 and 6 months. In deep pockets (7 mm), the test treatment resulted in an additional 1.4 mm (95% confidence interval 0.8, 2.0 mm) in full‐mouth probing pocket depth (PPD) reduction and 1 mm (0.7, 1.3 mm) of life cumulative attachment loss (LCAL) gain at 6 months. In moderate pockets (4–6 mm), the adjunctive benefit was smaller in magnitude: PPD reduction was 0.4 mm (0.1, 0.7 mm) and LCAL gain was 0.5 mm (0.2, 0.8 mm). In addition, the 6‐month data showed LCAL gains 2 mm at 25% of sites in test patients compared with 16% in placebo (p=0.028). Similarly, PPD reductions of 2 mm or more were observed in 30% of sites in test and 21% of sites in placebo patients. Seventy‐four percent of pockets with PPD 5 mm at baseline were 4 mm or shallower at 6 months in the test group. This compared with 54% in the placebo group (p=0.008). Disease progression at 6 months was observed at 1.5% of test and 3.3% of sites in test and placebo, respectively (p=0.072). Conclusions: These data indicate that a 7‐day adjunctive course of systemic metronidazole and amoxicillin significantly improved the short‐term clinical outcomes of full‐mouth non‐surgical periodontal debridement in subjects with GAP.