The use of systemic antibiotics in the treatment of refractory periodontitis : A systematic review

BackgroundThe goal in treating refractory periodontitis (RP) is to arrest or slow disease progression, which usually has included the use of systemic antibiotics adjunct to conventional mechanical debridement. The aim of this systematic review was to evaluate the evidence that the association of systemic antibiotics with conventional mechanical debridement increases the efficacy of periodontal therapy in the treatment of RP.Types of Studies ReviewedThe authors searched for studies in PubMed MEDLINE, Cochrane Central Register of Controlled Trials, Thomson Reuters Web of Science, Scopus, Latin American and Caribbean Center on Health Sciences Information, and Scientific Electronic Library Online electronic databases by using selected key words from the earliest records up through October 31, 2014. Only clinical intervention studies in which investigators compared the treatment of participants with RP with either mechanical debridement alone or associated with systemic antibiotics were eligible for selection. Two authors independently assessed the risk of bias of each selected study.ResultsThe authors identified 13 articles and included 6 of them. Investigators in all studies reported greater reductions in probing depth or in loss of clinical attachment level after adjunct systemic antibiotic therapy when compared with mechanical debridement alone. Antibiotics tested included metronidazole, clindamycin, tetracycline hydrochloride, amoxicillin, and amoxicillin and potassium clavulanate. Five studies presented a high risk of bias, and 1 study presented an unclear risk.Conclusions and Practical ImplicationsThe overall quality of the evidence does not allow the conclusion that adjunct systemic antibiotics are of additional benefit to conventional mechanical debridement alone.