Metronidazole plus amoxycillin in the treatment of Actinobacillus associated periodontitis

The potential use of an adjunctive therapy of metronidazole plus amoxycillin for the subgingival elimination of Actinobacillus actinomycetemcomitans in periodontitis patients was investigated. 22 patients participated in this study, 11 with localized juvenile periodontitis (LJP) and 11 with rapidly progressive periodontitis (RPP). 14 patients had received periodontal treatment in the past. All patients were subgingivally infected with A. actinomycetemcomitans. After mechanical subgingival debridement in combination with the antibiotic treatment, elimination of A. actinomycetemcomitans was achieved in all patients but one. With this one exception, clinical improvements were observed in all patients, resulting in reduced pocket probing depths as well as in a significant reduction in bleeding on probing. Re-examination of 16 patients after 9-11 months revealed that A. actinomycetemcomitans was still undetectable and further clinical improvement was observed. It was concluded that the combination of metronidazole plus amoxycillin is a valuable adjunct to mechanical therapy in A. actinomycetemcomitans associated periodontal infections.     

Clinical and microbiological effects of different antimicrobials on generalized aggressive periodontitis

AIM: To evaluate and compare the effects of adjunctive metronidazole plus amoxicillin, doxycycline and metronidazole on clinical and microbiological parameters in patients with generalized aggressive periodontitis. MATERIAL AND METHODS: Forty-three patients participated in this randomized clinical trial divided into four groups. Six weeks after scaling and root planning (SRP), groups 1-3 received adjunctive metronidazole, plus amoxicillin, doxycycline and metronidazole respectively, and group 4 acted as controls. Clinical recordings concerning probing depth, probing attachment level and bleeding on probing were performed at baseline, 6 weeks after SRP and 6 months from baseline. Subgingival samples were analysed using the 'checkerboard' DNA-DNA hybridization for Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Tannerella forsythia and Treponema denticola. Results: All treatments resulted in improvement of clinical parameters (ANOVA p > 0.05). Systemic administration of metronidazole plus amoxicillin or metronidazole resulted in statistically significant greater reduction of the proportion of sites > 6 mm than SRP (z-test, p < 0.05). These antimicrobials yielded a significant effect on levels of important periodontal pathogens for 6 months. CONCLUSION: Adjunctive metronidazole plus amoxicillin or metronidazole alone (when A.actinomycetemcomitans is not involved) is effective in deep pockets of aggressive periodontitis patients.     

Rationale for use of antibiotics in periodontics

The purpose of this review is to provide the clinician with some practical rationale for the selection and use of antibiotics in the treatment of destructive periodontal diseases. We have attempted to integrate approximately 20 years of periodontal literature describing antibiotic therapy with personal experience and 21st century ideas. This article addresses antibiotic use during treatment of aggressive periodontitis with emphasis on juvenile disease and adult refractory diseases. The literature review revealed few large, controlled studies that compared efficacy of adjunctive antibiotic use to mechanical therapy alone. Even fewer studies evaluated the efficacy of one antibiotic relative to another. However, based on the evidence available, certain conclusions were drawn. Adjunctive use of an antibiotic along with mechanical debridement is recommended for the treatment of Actinobacillus actinomycetemcomitans-associated periodontitis as an acceptable therapeutic regimen. Due to the emergence of tetracycline-resistant A. actinomycetemcomitans, the combination of metronidazole and amoxicillin may be preferable. In aggressive refractory periodontitis, compelling evidence exists that the use of an appropriate adjunctive antibiotic frequently gives a more favorable clinical response than mechanical therapy alone. Unfortunately, the selection of antibiotic is not as clear and is probably case-dependent. Positive responses have been reported with amoxicillin/clavulanic acid, clindamycin, metronidazole, and the combination therapy metronidazole plus amoxicillin. The introduction of local delivery antibiotics specifically for the treatment of periodontitis offers a novel concept for the treatment of localized disease. The latter, in particular, may prove useful in the treatment of recurrent disease activity or where only a few individual sites are involved.     

Microbiology in diagnosis and treatment of severe periodontitis. A report of four cases

The purpose of this report is to illustrate the use of microbiology in the diagnosis and treatment in four cases of severe adult periodontitis. All four patients were subgingivally infected with Actinobacillus actinomycetemcomitans which was the basis for an adjunct minocycline therapy. Scaling and root planing plus minocycline were not able to establish a clinically stable periodontal condition. A. actinomycetemcomitans was not eliminated from the pockets in any of the patients. Good clinical and microbiological results were obtained after continuous conventional treatment with an adjunct therapy of metronidazole plus amoxycillin. With a 7 day course of this antibiotic therapy, the pockets of all four patients became free of A. actinomycetemcomitans and were still negative on repeated sampling on recall visits. Microbiological monitoring of severe periodontitis in adults seems to be a valuable adjunct to clinical examination. Furthermore, effective antibiotic therapy in A. actinomycetemcomitans-associated periodontitis appears of paramount importance in obtaining a stable periodontal situation.     

Microbiological and clinical effects of metronidazole and amoxicillin in Actinobacillus actinomycetemcomitans associated periodontitis

Abstract In this study, we evaluated the microbiological and clinical effects of mechanical debridement in combination with metronidazole and amoxicillin therapy in 48 patients with Actinobacillus actinomycetemcomitans-associated periodontitis, 3 months and at least 24 months after active treatment. The results of this study showed that 47 out of 48 patients were still negative for A. actinomycetemcomitans subgingivally, at the mucous membranes, the tonsillar area and in the saliva, 2 years after therapy. The clinical results showed that a reduction of probing pocket depth, probing attachment level, bleeding index and plaque index was not only seen in the time between baseline and 3 months after therapy, but further clinical improvement was observed between 3 and 24 months after active treatment. We conclude that combined mechanical debridement and metronidazole plus amoxicillin therapy is very effective in suppressing A. actinomycetemcomitans below cultivable levels over a long period of time, suggesting elimination of this organism, and that recolonization of A. actinomycetemcomitans seems to be a rare event. The elimination of A. actinomycetemcomitans is paralleled by a further improvement of the periodontal status of the patients, even up to 24 months after active treatment.     

Adjunctive effects of systemic amoxicillin and metronidazole with scaling and root planing: a randomized, placebo controlled clinical trial

AIMS: The objective of this study was to investigate the effect of the systemic administration of metronidazole and amoxicillin as an adjunct to initial periodontal therapy in patients with moderate to severe chronic periodontitis. METHODS AND MATERIALS: This randomized, double blind, placebo controlled parallel study involved 50 adult patients with untreated periodontitis who were randomly assigned to receive either a full-mouth scaling and root planing along with systemic metronidazole and amoxicillin (T group) or scaling and root planing with a placebo (P group). Clinical measurements including probing depth (PD), clinical attachment levels (CAL), Plaque Index (PI), and Bleeding Index (BI) were recorded at baseline and six to eight weeks after therapy. The deepest pocket was selected and samples for microbiological testing were taken. Patients received coded study medications of either 500 mg amoxicillin in combination with 250 mg metronidazole or an identical placebo every eight hours for seven days following scaling and root planing. RESULTS: There was a significant change in PD (P=0.0001), CAL (P=0.00001), PI (P<0.05), and BI (P<0.05) in the T group compared to the placebo group after therapy. Parallel to the clinical changes, treatment significantly reduced the number of Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and P. intermedia (Pi) compared with baseline in the T group (P=0.003, 0.021 and 0.0001, respectively). However, in the P group only the Pi colony count was reduced significantly (P=0.0001). After therapy, there was a significant difference between the T and P groups in the number of patients negative for Aa, Pg, and Pi (Pv = 0.033). CONCLUSIONS: The significant differences between treatment and placebo groups are in line with other studies and support the considerable adjunctive benefits of the combination of amoxicillin and metronidazole in the treatment of chronic periodontitis.     

Differential clinical treatment outcome after systemic metronidazole and amoxicillin in patients harboring Actinobacillus actinomycetemcomitans and/or Porphyromonas gingivalis

Abstract. 48 adult patients with untreated periodontitis harboring subgingival Actinobacillus actinomycetemcomitans and/or Porphyromonas gingivalis as assessed by PCR were randomly assigned to receive full-mouth sealing alone (control) or scaling with systemic metronidazole plus amoxicillin and supragingival irrigation with chlorhexidine digluconate (test). In patients harboring A. actinomycetemcomitans intraorally at baseline, the adjunctive antimicrobial therapy resulted in a significantly higher incidence of probing attachment level (PAL) gain of 2 mm or more compared to scaling alone over 12 months (P< 0.05). In addition, suppression of A. actinomycetemcomitans in subgingival plaque below delectable levels was associated with an increased incidence of PAL gain. In contrast, patients initially harboring P. gingivalis but not A. actinomycetemcomitans in the oral cavity showed a significantly higher incidence of PAL loss following adjunctive antimicrobial therapy compared to scaling alone (P<0.05). When the presence of pathogens at baseline was disregarded in the analysis, adjunctive antimicrobial therapy did not significantly enhance clinical treatment outcome. The results indicated that adults with untreated periodontitis harboring A. actinomycetemcomitans may benefit from the adjunctive antimicrobial therapy for a minimum of 12 months, whereas, the regimen may adversely affect the clinical treatment outcome of patients harboring P. gingivalis but not A. actinomycetemcomitans.     

Intraoral persistence ofActinobacillus actinomycetemcomitansin periodontally healthy subjects following treatment of diseased family members

A. actinomycetemcomitans (Aa) can be transmitted among family members. The purpose of the present study was, to evaluate, whether A. actinomycetemcomitans is able to persist for a prolonged period of time in periodontally healthy subjects following elimination of this pathogen from diseased family members. In 14 periodontitis patients harboring Aa as well as in their 37 family members, the clinical (PPD, PAL, P1I, GI) and microbiological status (TSBV) was evaluated. After study patients received mechanical, surgical and antibiotic (3x375 mg amoxicillin+3x250 mg metronidazole/7 d) treatment, they, as well as their family members, were reassessed 3, 6, 9 and 12 months following therapy. From 13 spouses, 4 (31%) had periodontitis associated with Aa, 4 (31%) had periodontitis and no Aa, 2 (15%) were periodontally healthy and harbored Aa, 3 (23%) were healthy with no detection of Aa. From 24 off-springs, one (4%) had periodontitis associated with Aa, 8 (33%) were healthy and harbored Aa, 15 (63%) were healthy with no detection of Aa. In the 2 spouses and in 7 of the 8 offsprings being healthy, but harboring Aa, this pathogen still persisted at the 12-month appointment, after it had been eliminated from the diseased family members. Only one child became negative for Aa after 12 months. The results of this study indicate that A. actinomycetemcomitans is able to persist in the oral habitats of periodontally-healthy subjects for at least 12 months, after this pathogen had been eliminated from diseased family members. This might suggest that also in healthy family members, A. actinomycetemcomitans as a source of transmission should be eliminated to prevent reinfection.     

Local antibiotic therapy guided by microbiological diagnosis

BACKGROUND: The aim of this study was to determine the distribution patterns of Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans in periodontitis patients after standard mechanical periodontal therapy, and to evaluate the effect of additional local antibiotic therapy, given to all teeth with cultural evidence of these bacteria. METHODS: 17 patients were included. 852 separate subgingival microbial samples were taken from the mesial and distal aspect of every tooth in 17 subjects at baseline. 46 of these samples, from 10 positive subjects, showed cultural evidence for P. gingivalis. 82 samples, from 5 subjects, were A. actinomycetemcomitans-positive. Three subjects showed no evidence for persistence of A. actinomycetemcomitans or P. gingivalis. In the other 14 subjects, all A. actinomycetemcomitans- or P. gingivalis-positive teeth were treated with tetracycline fibers (ACTISITE(R)). Sub-gingival microbial samples were again taken from two sites of every tooth, 1 month after fiber removal. 89% of the initially P. gingivalis-positive sites were now negative, but 16 previously negative sites now tested positive. 77% of the initially A. actinomycetemcomitans-positive sites were now negative, but 5 previously negative sites now tested positive. The teeth with persisting P. gingivalis or A. actinomycetemcomitans were again treated with fibers. Two sites of every tooth were once more sampled after 1 month. At this time, 5 subjects still showed cultural evidence of P. gingivalis at a total of 19 sites, and 4 subjects were positive for A. actinomycetemcomitans in a total of 27 sites. These 9 patients were finally submitted to systemic antibiotic therapy (3 x 250 mg metronidazole plus 3 x 375 mg amoxicillin/d for 7 days). Despite of all efforts, P. gingivalis was again detected 3 months later in isolated sites in 3 subjects, and A. actinomycetemcomitans could be cultivated from one single site. CONCLUSIONS: Therapy with tetracycline fibers guided by microbiological diagnosis effectively reduced P. gingivalis and A. actinomycetemcomitans locally, but was unable to completely eradicate the target organisms. Additional systemic antibiotic therapy further reduced P. gingivalis and A. actinomycetemcomitans. The observed persistence patterns suggest that reemergence of A. actinomycetemcomitans was due to recolonization, whereas the strikingly reproducible local reemergence of P. gingivalis in some sites indicated failed eradication.     

Metronidazole in the treatment of refractory periodontitis

In this article the clinical and microbiological effects of systemic metronidazole in the treatment of refractory periodontitis in adult patients is discussed. For this study, 27 adult patients with detectable Bacteroides forsythus and culture negative for Actinobacillus actinomycetemcomitans were selected. After renewed supra- and subgingival debridement, patients were treated with systemic metronidazole (500 mg TID) for 7 days. Mean probing pocket depth, probing attachment level and bleeding index significantly improved after metronidazole therapy. Patients that became culture negative for B. forsythus showed a significant better therapy response in comparison to subjects that had detectable B. forsythus post-therapy. The maximum clinical response was observed in patients that became negative for B. forsythus, Porphyromonas gingivalis and Prevotella intermedia after renewed debridement and metronidazole therapy. It is concluded that systemic metronidazole therapy can be effective in refractory adult periodontitis. Microbiological analyses of the subgingival microflora in these patients can assist in selecting patients that may benefit from systemic metronidazole therapy.     

The use of metronidazole and amoxicillin in the treatment of advanced periodontal disease

Abstract. The present clinical trial was performed to study the effect of systemic administration of metronidazole and amoxicillin as an adjunct to mechanical therapy in patients with advanced periodontal disease. 16 individuals, 10 female and 6 male, aged 35–58 years, with advanced periodontal disease were recruited. A baseline examination included assessment of clinical. radiographical, microbiological and histopathological characteristics of periodontal disease. The 16 patients were randomly distributed into 2 different samples of 8 subjects each. One sample of subjects received during the first 2 weeks of active periodontal therapy, antibiotics administered via the systemic route (metronidazole and amoxicillin). During the corresponding period, the 2nd sample of subjects received a placebo drug (placebo sample). In each of the 16 patients, 2 quadrants (1 in the maxilla and 1 in the mandible) were exposed to non-surgical subgingival scaling and root planing. The contralateral quadrants were left without subgingival instrumentation. Thus, 4 different treatment groups were formed; group 1: antibiotic therapy but no scaling, group 2: antibiotic therapy plus scaling, group 3: placebo therapy but no scaling, group 4: placebo therapy plus scaling. Re-examinations regarding the clinical parameters were performed, samples of the subgingival microbiota harvested and 1 soft tissue biopsy from 1 scaled and 1 non-scaled quadrant obtained 2 months and 12 months after the completion of active therapy. The teeth included in groups 1 and 3 were following the 12-month examination exposed to non-surgical periodontal therapy, and subsequently exited from the study. Groups 2 and 4 were also re-examined 24 months after baseline. The findings demonstrated that in patients with advanced periodontal disease, systemic administration of metronidazole plus amoxicillin resulted in (i) an improvement of the periodontal conditions, (ii) elimination/suppression of putative periodontal pathogens such as A. actinomycetemcomitans, P. gingivalis, P. intermedia and (iii) reduction of the size of the inflammatory lesion. The antibiotic regimen alone, however, was less effective than mechanical therapy with respect to reduction of BoP—positive sites, probing pocket depth reduction, probing attachment gain. The combined mechanical and systemic antibiotic therapy (group 2) was more effective than mechanical therapy alone in terms of improvement of clinical and microbiological features of periodontal disease.     

Controlled-delivery chlorhexidine chip versus amoxicillin/metronidazole as adjunctive antimicrobial therapy for generalized aggressive periodontitis: a randomized controlled clinical trial

BACKGROUND: Subgingival application of chlorhexidine via a controlled-delivery device (CHX chip) improves the clinical outcome of scaling/root planing (SRP) in therapy for chronic periodontitis. Generalized aggressive periodontitis (GAP) is commonly treated with SRP and adjunctive antimicrobial medication. To date, the efficacy of CHX chips in GAP therapy has not been evaluated. AIM: To compare SRP plus adjunctive CHX chip placement with SRP plus adjunctive systemic amoxicillin/metronidazole with regard to clinical efficacy in first-line therapy for GAP. MATERIAL AND METHODS: Thirty-six GAP patients were treated with SRP and randomly with either placement of CHX chips or systemic amoxicillin/metronidazole. Clinical attachment level (CAL), probing depth (PD), bleeding on probing (BoP) and suppuration (Pus) were measured at baseline, 3 and 6 months after therapy. RESULTS: CAL, PD, BoP and Pus were significantly reduced in both groups after 3 months. In the CHX chip group, PD significantly increased again between 3 and 6 months. Finally, amoxicillin/metronidazole patients presented significantly more CAL "gain", PD reduction and less remaining deep sites after 6 months. Pus remained detectable in CHX chip patients only. CONCLUSIONS: In first-line non-surgical therapy for GAP, SRP plus adjunctive systemic amoxicillin/metronidazole was more efficacious in clinically relevant measures of outcome than SRP plus adjunctive placement of CHX chips.     

Combined mechanical and antibiotic periodontal therapy in a case of Papillon-Lefèvre syndrome

BACKGROUND: Papillon Lefèvre syndrome (PLS) is a rare entity and, as such, it is almost impossible to evaluate an effective therapy in a randomized controlled study. The amount of success reported after therapy for prepubertal periodontitis (PP) in PLS is highly variable from case to case. The goal of this case report is to evaluate the effects of a combined mechanical and antibiotic periodontal therapy regimen in the management of PLS. METHODS: A male patient was diagnosed as suffering from PP associated with PLS at the age of 7 years. He showed hyperkeratosis of the palms and soles, as well as advanced periodontal disease already affecting permanent teeth with maximal probing depth and vertical attachment loss of 12 mm and 11 mm, respectively. Subgingival debridement was performed with simultaneous administration of oral 250 mg amoxicillin 3 times daily and 250 mg metronidazole twice daily for one week. Clinical parameters were assessed and subgingival plaque was collected from all teeth prior to therapy and 7 and 26 months after treatment. Selective cultures for A. actinomycetemcomitans were incubated for each individual tooth and DNA probe analysis was performed for various periodontal pathogens. RESULTS: Prior to combined mechanical and antibiotic treatment, all teeth but one harbored Actinobacillus actinomycetemcomitans subgingivally. However, at 7 and 26 months after therapy A. actinomycetemcomitans could be detected neither by culture nor by DNA probes. Clinical parameters improved markedly and teeth erupting after therapy did not exhibit attachment loss of more than 1.5 mm during the observation period. CONCLUSIONS: Eradication (suppression beneath detection levels) of A. actinomycetemcomitans seems to play a significant role in the successful treatment of localized prepubertal periodontitis in PLS.     

Clinical and microbiological effects of initial periodontal therapy in conjunction with amoxicillin and clavulanic acid in patients with adult periodontitis

The aim of the present study was to investigate the clinical and microbiological effects of initial periodontal therapy in conjunction with systemic amoxicillin plus clavulanic acid in adult periodontitis patients using a double-blind, parallel-group, and placebo-controlled protocol. 21 patients with a clinical diagnosis of generalised adult periodontitis were recruited. Clinical measurements and microbiological assessments were carried out at baseline, 3, and 12 months post-treatment. Approximately 6 weeks after initial periodontal treatment (3-6 h), patients were randomly assigned to receive coded study medication of 500 mg amoxicillin plus 125 mg clavulanic acid (Augmentin) or placebo, every 8 h for 10 days. Patients returned for follow-up visits 3, 6, 9, and 12 months after completion of the medication. The mean plaque index (PI) at baseline was 1.1 for placebo group and 0.9 for the test group. At 3 months, the PI had dropped to 0.3 in both groups, and was maintained during the rest of the study. The changes in bleeding on probing (BOP) and gingival index (GI) in the course of the study were similar in both groups. The mean whole mouth probing pocket depth (PPD) in the placebo group was 3.8 mm at baseline and 3.9 mm in the test group. A mean reduction of 1.0 mm in the placebo group and 0.9 mm in the test group was observed during the first 3 months. No further reduction in PPD was noticed during the study period in either group. There was no statistically significant difference in the PPD reduction between the 2 groups. The change in clinical attachment level (CAL) from baseline to 3 months amounted to 0.5 mm in both groups. Between 3 and 12 months, the CAL changed in neither group. In both groups, treatment resulted in a decrease in the number of spirochetes and motile rods in positive patients, but no significant differences between either group were noted in any of the dark field microscopy observations. At baseline, 1 patient in the placebo group and 2 patients in the test group were culture positive for Actinobacillus actinomycetemcomitans (Aa). After therapy, Aa was not detectable in the placebo group and 1 patient remained positive in the test group. In the placebo group, the number of patients positive for Porphyromonas gingivalis (Pg) decreased from 7 to 2 after therapy. In the test group, the 4 patients positive for Pg at baseline remained positive after therapy. In both groups, all subjects were positive for Prevotella intermedia (Pi) and Fusobacterium nucleatum (Fn) at baseline. At 12 months, all subjects had detectable subgingival Fn. 9 out of the 11 placebo and 8 of the 10 test patients remained positive for Pi. There were no differences in detection frequency of Peptostreptococcus micros (Pm) and Bacteroides forsythus (Bf) in both groups between baseline, 3, and 12 months post-treatment. The findings demonstrated that, in comparison to placebo, systemic amoxicillin plus clavulanic acid provided no additional clinical and microbiological effects in the treatment of adult periodontitis patients.     

Comparative study of 2 antibiotic combinations in the treatment of rapidly progressing periodontitis.]

To get rid efficiently of anaerobics bacteria, which constituted the flora associated to periodontitis, the periodontal therapy is now moving towards 2 or 3 antibiotics association. The aim of this study is to make a comparison between the efficacy of the association of amoxicillin plus clavulanic acid and that of amoxicillin plus metronidazole into 20 patients suffering from rapidly progressive periodontitis. The results have shown that both forms of antibiotics association are efficacious in rapidly progressive periodontitis treatment, with the same action on clinical parameters.     

Actinobacillus actinomycetemcomitans in destructive periodontal disease. Three-year follow-up results

BACKGROUND: Convincing data exist that A. actinomycetemcomitans is an etiologic agent of periodontal disease. The purpose of this longitudinal study was to evaluate A. actinomycetemcomitans as a diagnostic indicator for periodontal disease in treated and periodontally maintained patients. METHODS: Following comprehensive mechanical/surgical and supportive amoxicillin plus metronidazole therapy in 13 subjects with A. actinomycetemcomitans-associated destructive periodontal disease, we monitored subgingival A. actinomycetemcomitans at 4 individual sites in each patient up to 3 years post-therapy. The periodontal status was determined, and A. actinomycetemcomitans levels were quantitatively enumerated on TSBV agar in CFU/ml. Six patients with a persistence of subgingival A. actinomycetemcomitans at each reexamination within 3 years post-therapy were selected to be at risk for minor periodontal treatment outcomes and further recurrence of periodontal disease (test group). Seven subjects with a complete suppression of A. actinomycetemcomitans at each post-therapy visit served as controls. RESULTS: The periodontal parameters decreased from overall values of 6.39 mm (probing depth, PD) and 7.64 mm (clinical attachment level, CAL) at the outset to 3.81 mm (PD) and 5.62 mm (CAL) 2 years post-therapy (Friedman, P< or =0.05). At the 3-year reexamination, the PD/CAL scores increased to 4.03/5.78 mm. Among the 6 individuals (46%) with persistence of subgingival A. actinomycetemcomitans at the final 3-year visit (test group), periodontal status yielded increased levels of 4.45 mm (PD) and 6.60 mm (CAL). The control subjects (n = 7) revealed lower values of 3.67 mm (PD) and 5.09 mm (CAL). However, on a patient level, during the 3-year observational trial, the periodontal status of the 13 individuals was not statistically affected by subgingival infection with A. actinomycetemcomitans. CONCLUSIONS: Although in advanced periodontal disease, comprehensive mechanical and antimicrobial treatment is an appropriate regimen for sustained improvement of periodontal health, long-term control of subgingival infection with A. actinomycetemcomitans could not be achieved. In the maintenance care of destructive periodontitis, the persistence of A. actinomycetemcomitans is not a diagnostic parameter for periodontal disease.     

Effects of metronidazole in patients with "refractory" periodontitis associated with Bacteroides forsythus

Abstract The aim of the present study was to monitor the microbiological and clinical effects of renewed supra and sub gingival debridement in conjunction with systemic metronidazole therapy (500 mg TID for 7 days) in 27 “refractory” periodontitis patients, culture positive for Bacteroides forsythus and negative for Actinobacillus actinomycetemcomitans. Clinical evaluation included assessment of plaque, bleeding upon probing, probing pocket depth and clinical attachment loss at the deepest, bleeding site in each quadrant. Microbiological evaluation was carried out by anaerobic cultivation of sub gingival plaque samples from the same sites. 6 months after renewed debridement and systemic metronidazole (RD + M). a statistically significant improvement of all clinical parameters was observed, except for the plaque index. After RD + M, B. forsythus was suppressed below detection level in 17 of the 27 patients, P. gingivalis in 9 out of 15 patients and P. intermedia in 14 of the 21 patients. Before RD+M. 12 patients harboured simultaneously B. forsythus, P. gingivalis as well as P. intermedia. Out of these 6 patients were culture negative for the 3 species after therapy and showed the greatest reduction in pocket depth (3.1 mm) and gain of clinical attachment level (2.5 mm). In the treatment of refractory periodontitis. associated with patients culture positive for B. forsythus and negative for A. actinomycetemcomitans, metronidazole can significantly improve the clinical and microbiological parameters.     

Interleukin-1 haplotype and periodontal disease progression following therapy

The purpose of this study was to assess the prognostic value of the IL-1 haplotype on the progression of periodontal disease following therapy. 48 adult patients with untreated periodontitis harboring Actinobacillus actinomycetemcomitans and/or Porphyromonas gingivalis were randomly assigned to receive full-mouth scaling alone (control) or in combination with systemic metronidazole plus amoxicillin and supragingival irrigation with chlorhexidine digluconate (test). All patients received supportive periodontal therapy at 3 to 6 months intervals. In 33 patients, lymphocyte DNA was analyzed for polymorphism in the IL-1A gene at position -889 and IL-1B gene at position +3953. Overall, 16 of 33 patients (7 of 17 test and 9 of 16 control) carried the IL-1 haplotype. 2 years following initial periodontal therapy, no differences in the survival rates of sites or teeth not exhibiting probing attachment loss of 2 mm or more compared to baseline, were found between patients who tested positive (85% sites, 53% teeth) and patients who tested negative (89% sites, 56% teeth) for the IL-1 haplotype. The results indicated that the IL-1 haplotype may be of limited value for the prognosis of periodontal disease progression following non-surgical periodontal therapy.     

Amoxicillin plus metronidazole in the treatment of adult periodontitis patients. A double-blind placebo-controlled study

BACKGROUND, AIMS: The aim of this double-blind, parallel study was to evaluate the adjunctive effects of systemically administered amoxicillin and metronidazole in a group of adult periodontitis patients who also received supra- and subgingival debridement. METHODS: 49 patients with a diagnosis of generalised severe periodontitis participated in the study. Random assignment resulted in 26 patients in the placebo (P) group with a mean age of 40 years and 23 patients in the test (T) group which had a mean age of 45 years. Clinical measurements and microbiological assessments were taken at baseline and 3 months after completion of initial periodontal therapy with additional placebo or antibiotic treatment. Patients received coded study medication of either 375 mg amoxicillin in combination with 250 mg metronidazole or identical placebo tablets, every 8 hours for the following 7 days. RESULTS: At baseline, no statistically significant differences between groups were found for any of the clinical parameters. Except for the plaque, there was a significantly larger change in the bleeding, probing pocket depth (PPD) and clinical attachment level (CAL) in the T-group as compared to the P-group after therapy. The greatest reduction in PPD was found at sites with initial PPD of > or = 7 mm, 2.5 mm in the P-group and 3.2 mm in the T-group. The improvement in CAL was most pronounced in the PPD category > or = 7 mm and amounted to 1.5 mm and 2.0 mm in the P- and T-groups, respectively. No significant decrease was found in the number of patients positive for any of the test species in the P-group. The number of patients positive for Porphyromonas gingivalis, Bacteroides forsythus and Prevotella intermedia in the T-group showed a significant decrease. After therapy there was a significant difference between the P- and the T- group in the remaining number of patients positive for P. gingivalis, B. forsythus and Peptostreptococcus micros. 4 subgroups were created on the basis of the initial microbiological status for P. gingivalis positive (Pg-pos) and negative patients (Pg-neg) in the P- and the T-groups. The difference in reduction of PPD between Pg-pos and Pg-neg patients was particularly evident with respect to the changes in % of sites with a probing pocket depth > or = 5 mm. This % decreased from 45% at baseline to 23% after treatment in the Pg-pos placebo subgroup and decreased from 46% to 11% in the Pg-pos test subgroup (p < or = 0.005). In contrast, the changes in the proportions of sites with a probing pocket depth > or = 5 mm in the Pg-neg placebo and Pg-neg test subgroup were similar, from 43% at baseline to 18% after treatment versus 40% to 12% respectively. CONCLUSIONS: This study has shown that systemic usage of metronidazole and amoxicillin, when used in conjunction with initial periodontal treatment in adult periodontitis patients, achieves significantly better clinical and microbiological results than initial periodontal treatment alone. Moreover, this research suggests that especially patients diagnosed with P. gingivalis benefit from antibiotic treatment.