Dataset Information

Clinical benefits of systemic amoxicillin/metronidazole may depend on periodontitis severity and patients' age: An exploratory sub-analysis of the ABPARO trial.

ABSTRACT:

Aim

The aim was to identify benefit thresholds for clinical variables. We hypothesize, if variables fall below or exceed these threshold levels, systemic amoxicillin/metronidazole may contribute to reducing progression of periodontitis.

Material & methods

This is an explorative per-protocol collective analysis (n = 345) conducted on the placebo-controlled, multi-centre ABPARO trial (ClinicalTrials.gov NCT00707369). Patients received debridement with systemic amoxicillin 500 mg/metronidazole 400 mg (3×/day, 7 days, n = 170) or placebo (n = 175) and maintenance therapy every three months. To identify thresholds, each of the following baseline characteristics was classified into two groups (≥threshold value/ResultsAdjunctive antimicrobials reduced median new attachment loss in patients < 55 years (5.2%), or with ≥ 35% PPD ≥ 5 mm (4.5%) or with a mean attachment level > 5 mm (5.2%) at baseline compared to the placebo (9.0%, 11.6%, and 12.5%, respectively; p < 0.005).

Conclusions

The clinical benefits of systemic amoxicillin/metronidazole may depend on periodontitis severity and patients' age.

SUBMITTER: Eickholz P

PROVIDER: S-EPMC6594242 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Publications

Clinical benefits of systemic amoxicillin/metronidazole may depend on periodontitis severity and patients' age: An exploratory sub-analysis of the ABPARO trial.

Eickholz Peter P Koch Raphael R Kocher Thomas T Hoffmann Thomas T Kim Ti-Sun TS Meyle Joerg J Kaner Doğan D Schlagenhauf Ulrich U Harmsen Dag D Harks Inga I Ehmke Benjamin B

Journal of clinical periodontology 20190412 4

<h4>Aim</h4>The aim was to identify benefit thresholds for clinical variables. We hypothesize, if variables fall below or exceed these threshold levels, systemic amoxicillin/metronidazole may contribute to reducing progression of periodontitis.<h4>Material & methods</h4>This is an explorative per-protocol collective analysis (n = 345) conducted on the placebo-controlled, multi-centre ABPARO trial (ClinicalTrials.gov NCT00707369). Patients received debridement with systemic amoxicillin 500 mg/met ...[more]

PMID: 30825384

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Project description:Systemic amoxicillin-metronidazole was proven to be effective in managing periodontitis in systemically healthy patients. It was demonstrated that systemic antibiotic therapy can effectively improve clinical periodontal parameters and reduce periodontopathogenic organisms in the subgingival biofilm. However, the evidence for prescribing this drug combination to patients with diabetes remains insufficient. This systematic review was designed to evaluate the effectiveness of a systemic amoxicillin-metronidazole combination as an adjunct to nonsurgical periodontal therapy in patients with diabetes presenting with chronic periodontitis. The PubMed, Scopus, and Web of Science databases were electronically searched for randomized clinical trials in January 2022. Randomized clinical trials evaluating systemic amoxicillin-metronidazole therapy as an adjunct to nonsurgical periodontal therapy in patients with type 2 diabetes presenting with periodontitis were selected for screening. The qualities of the studies were assessed using the Cochrane Collaboration's Tool for Assessing Risk of Bias Version 2.0 (ROB-2), and a GRADE assessment was applied to estimate the overall certainty of the evidence. Using predefined eligibility criteria, four clinical trials examining 209 patients were selected from the 611 articles identified in the search. Two studies reported a better reduction in clinical parameters when SRP was combined with systemic amoxicillin-metronidazole. Systemic amoxicillin-metronidazole was found to be as effective as clindamycin. Surgical therapy with systemic amoxicillin-metronidazole was more effective than nonsurgical therapy with systemic amoxicillin-metronidazole, even though both resulted in reduced clinical parameters. Combined amoxicillin-metronidazole was observed to reduce periodontal probing depth (PPD), clinical attachment level (CAL), and bleeding on probing (BOP) compared to no treatment or NSPT alone. However, the effect was not greater when compared to NSPT with clindamycin or surgical therapy with amoxicillin-metronidazole. Further randomized trials are required before clinical guidelines can be established for the use of systemic amoxicillin-metronidazole. Future randomized controlled clinical trials with long-term follow-ups are required to assess the efficacy of systemic antibiotic therapy in managing periodontitis in patients with diabetes.

Project description:BackgroundThe combination of systemic metronidazole (MTZ) and amoxicillin (AMX) with scaling and root planing (SRP) has shown to be an effective periodontal treatment. However, some essential issues associated with the use of these antibiotics remain unanswered, such as the ideal time of administration during the course of periodontal treatment. Although these agents are often prescribed after the healing phase of the SRP procedure, there is biological plausibility to support its use in conjunction with the mechanical treatment. However, to date, no placebo controlled randomized clinical trial (RCT) has directly compared these two protocols. Therefore, the aim of this RCT is to compare the clinical, microbiological and immunological effects of the adjunctive systemic MTZ + AMX administered in different phases of the treatment of severe periodontitis.MethodsSubjects with severe periodontitis (n = 180) are being randomly assigned into three groups (n = 60/group): (i) SRP-only (control group), SRP in combination with 400 mg MTZ + 500 mg AMX, starting (ii) at the first SRP session (active phase group), or (iii) after 3 months of its completion (healing phase group). All volunteers are receiving clinical and microbiological evaluation at baseline, 3, 6 and 12 months, and immunological assessment at baseline and 12 months post-therapy. Nine subgingival biofilm samples are being collected per subject and analyzed for counts and proportions of 40 bacterial species by checkerboard DNA-DNA hybridization, and six gingival crevicular fluid samples are being collected and analyzed for the levels of 20 chemokines by multiplex immunoassay. The primary outcome variable is the number of volunteers reaching the clinical endpoint for treatment (≤ 4 sites with probing depth ≥5 mm) at 1 year post-therapy. Differences in clinical, microbiological and immunological parameters among groups and over time will be evaluated using analysis of variance, analysis of covariance and the Chi-square and Tukey tests. Microbiological and immunological analyses will be performed using adjustments for multiple comparisons. Statistical significance will be set at 5%.Trial registrationClinicalTrials.gov , NCT02954393 . Registered on 3 November 2016.

Project description:BackgroundPeriodontitis is a periodontal inflammatory disease closely related to hypertension. However, the role of age and systemic inflammation is unclear. This study examined the effect of age and systemic inflammation on the association between severity of periodontitis and blood pressure in periodontitis patients.MethodsThis cross-sectional clinical study included periodontitis patients treated at Beijing Chaoyang Hospital, Capital Medical University from January 2020 to July 2023. Patients with periodontitis were included using inclusion and exclusion criteria, and data on basic information, blood pressure, periodontal examination indicators, and biochemical examination indicators were collected. Patients were grouped by blood pressure, and differences in basic information, blood indexes, and periodontal examination indexes between the two groups were compared by independent sample T-test. With PBOP as independent variables, systolic blood pressure (SBP) and diastolic blood pressure as dependent variables, and several indexes as covariables, the relationship between them was studied by linear regression. The interaction was used to explore the relationship between age and systemic inflammation in periodontitis and hypertension.ResultsA total of 144 patients with periodontitis were enrolled. In fully adjusted analyses, the percentage of site with bleeding on probing (PBOP) was significantly associated with SBP (B = 10.08, p = 0.027) in the overall group. In patients 50 years or older, but not in those younger than 50, PBOP remained significantly associated with SBP (p = 0.018 for interaction). The strength of association between PBOP and SBP was greater in patients with higher systemic immune-inflammation index. The regression coefficients of PBOP in the systemic immune-inflammation index ≥ 400 and < 400 groups were 16.61 (95% CI, 3.32-29.90; p = 0.015) and 13.69 (95% CI, 1.15-26.23; p = 0.033), respectively (p = 0.047 for interaction). Similar results were observed in the systemic inflammation response index ≥ 9 and < 9 groups (B = 17.04 (95% CI, 2.66-31.42, p = 0.021) and 13.98 (95% CI, 1.94-26.01, p = 0.024 respectively; p = 0.028 for interaction).ConclusionsThis study indicates a significant association between the severity of periodontitis and SBP, which was modified by age and systemic inflammation.

Project description:The aim of this follow-up study was, to compare the effects of mechanical periodontal therapy with or without adjunctive amoxicillin and metronidazole on the subgingival microbiome of smokers with periodontitis using 16S rDNA amplicon next generation sequencing. Fifty-four periodontitis patients that smoke received either non-surgical periodontal therapy with adjunctive amoxicillin and metronidazole (n = 27) or with placebos (n = 27). Subgingival plaque samples were taken before and two months after therapy. Bacterial genomic DNA was isolated and the V4 hypervariable region of the bacterial 16S rRNA genes was amplified. Up to 96 libraries were normalized and pooled for Illumina MiSeq paired-end sequencing with almost fully overlapping 250 base pairs reads. Exact ribosomal sequence variants (RSVs) were inferred with DADA2. Microbial diversity and changes on the genus and RSV level were analyzed with non-parametric tests and a negative binomial regression model, respectively. Before therapy, the demographic, clinical, and microbial parameters were not significantly different between the placebo and antibiotic groups. Two months after the therapy, clinical parameters improved and there was a significantly increased dissimilarity of microbiomes between the two groups. In the antibiotic group, there was a significant reduction of genera classified as Porphyromonas, Tannerella, and Treponema, and 22 other genera also decreased significantly, while Selenomonas, Capnocytophaga, Actinomycetes, and five other genera significantly increased. In the placebo group, however, there was not a significant decrease in periodontal pathogens after therapy and only five other genera decreased, while Veillonella and nine other genera increased. We conclude that in periodontitis patients who smoke, microbial shifts occurred two months after periodontal therapy with either antibiotics or placebo, but genera including periodontal pathogens decreased significantly only with adjunctive antibiotics.

Project description:Information on the systemic medication profiles of patients with periodontitis is limited. Therefore, this retrospective cross-sectional study aimed to analyze the relationship between the severity and rate of progression of periodontitis and systemic medication intake using a database of patients who attended the Clinic of Periodontics of the Faculty of Dentistry of the University of Costa Rica. Electronic health records of patients diagnosed with periodontitis based on the Classification of Periodontal and Peri-Implant Diseases and Conditions (2017) were evaluated. Individuals were further categorized based on the severity (stage) and rate of progression (grade). Data extracted from the patient records included age, sex, and self-reported medication intake. In total, 930 records were included. Most of the studied population was middle-aged (36-64 years old); 43.01% were male, and 56.99% were female. Four hundred and fifty-seven patients (49.14%) reported taking at least one systemic medication for a chronic condition. Regarding the periodontal treatment phase, 62.37% underwent steps 1-3, and 37.63% underwent step 4. The most common systemic medications taken were for cardiovascular diseases (42.28%), followed by medications for diabetes (14.46%) and neurologic disorders (14.46%). Most patients (59.35%) were diagnosed with Stage III periodontitis. Grade B (48.28%) was the most prevalent. Calcium channel blockers demonstrated a disease severity-dependent association with the periodontal stage (p = 0.021). In addition, systemic medications for diabetes mellitus were associated with periodontal disease severity and rate of progression (all Ps < 0.05). This study provides indirect evidence of the association between systemic diseases and periodontitis. The positive association between medications used to treat diabetes and the severity and rate of progression of periodontitis may be due to the underlying disease rather than the medications per se.

Dataset Information

Clinical benefits of systemic amoxicillin/metronidazole may depend on periodontitis severity and patients' age: An exploratory sub-analysis of the ABPARO trial.

Aim

Material & methods

Conclusions

Publications

Clinical benefits of systemic amoxicillin/metronidazole may depend on periodontitis severity and patients' age: An exploratory sub-analysis of the ABPARO trial.

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