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 Table of Contents  
Year : 2019  |  Volume : 7  |  Issue : 2  |  Page : 33

Systemic antibiotics in the treatment of periodontitis

Department of Periodontology, Faculty of Dentistry, Kocaeli University, Kocaeli, İzmit, Turkey

Date of Submission19-Sep-2019
Date of Decision25-Sep-2019
Date of Acceptance01-Jan-2000
Date of Web Publication22-Oct-2019

Correspondence Address:
Esra Guzeldemir-Akcakanat
Department of Periodontology, Faculty of Dentistry, Kocaeli University, Kocaeli, Basiskele
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/dmr.dmr_23_19

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How to cite this article:
Guzeldemir-Akcakanat E. Systemic antibiotics in the treatment of periodontitis. Dent Med Res 2019;7:33

How to cite this URL:
Guzeldemir-Akcakanat E. Systemic antibiotics in the treatment of periodontitis. Dent Med Res [serial online] 2019 [cited 2021 Dec 4];7:33. Available from: https://www.dmrjournal.org/text.asp?2019/7/2/33/269670

The 2001 Guinness Book of World Records list periodontal diseases as the most common disease of humankind. Gingivitis and periodontitis that are also chronic noncommunicable diseases are the most common type of periodontal diseases. Both are plaque-induced inflammatory conditions with multifactorial destructive nature. Initiation of the diseases requires the adherence of the pathogenic bacteria to tooth surfaces and triggering the inflammatory response in periodontal tissues. Hence, initial periodontal treatment of the diseases consists of mechanical debridement to remove bacterial plaque and calculus from the root surfaces. Maintenance of oral hygiene, scaling and root planing and periodontal surgeries if necessary provide expected results in most cases since the biofilm is disrupted mechanically.[1] However, when pathogenic bacteria are residing within periodontal tissues or in deep pockets or root furcation defects or root concavities or grooves, to access these sides for mechanical debridement would be limited.[2] Systemic antimicrobial therapy in periodontal treatment may provide benefits as an adjunct to mechanical periodontal debridement.[3] Especially, aggressive periodontitis patients have more benefits from nonsurgical therapy together with systemic antibiotics comparing to nonsurgical treatment alone.[4],[5],[6]

Systemic antibiotics, including amoxicillin (with or without clavulanic acid), azithromycin, clindamycin, doxycycline, metronidazole, spiramycin, moxifloxacin, tetracycline, and combination of these antibiotics have been investigated in clinical studies, and there are a number of reviews and meta-analyses on this subject.[7],[8]

Systemic administration of the antimicrobial agent may provide some advantages such as wide distribution all through the body which may increase the therapeutic potential of the agent, on the other hand, systemic administration requires good patient compliance and may cause of systemic side effects.

Periodontitis patients may not have an identical microbial profile and the antibiotic susceptibility/resistance of periodontopathogens for unique antibiotic regimes, so it seems it is not possible to provide a consensus in the administration of antibiotics in periodontitis patients.[9] Moreover, there is no consensus on timing of the antibiotic use and dosages, length of the antibiotic therapy, and the appropriate antibiotic agents or combinations due to the nature of the biofilm in the periodontal therapy. Usually, when there is no standard treatment protocols or consensus reports, antibiotics are often over-prescribed.[10]

The World Health Organization (WHO) has reported that “antibiotic resistance is rising dangerously high levels in all parts of the world and a growing list of infections are becoming harder, and sometimes impossible, to treat as antibiotics become less effective.”

The role of health professions in the action plan for the prevention and control of the antibiotic use by the WHO is described in detail as follows:

“To prevent and control the spread of antibiotic resistance, health professionals can,[10]
  • Prevent infections by ensuring your hands, instruments, and environment are clean
  • Only prescribe and dispense antibiotics when they are needed, according to the current guidelines
  • Report antibiotic-resistant infections to surveillance teams
  • Talk to your patients about how to take antibiotics correctly, antibiotic resistance, and the dangers of misuse
  • Talk to your patients about preventing infections (for example, vaccination, hand washing, safer sex, and covering nose and mouth when sneezing).

  • “A global action plan on antimicrobial resistance, including antibiotic resistance”, was endorsed at the World Health Assembly in May 2015. The global action plan aims to ensure the prevention and treatment of infectious diseases with safe and effective medicines.

    The “Global action plan on antimicrobial resistance” has five strategic objectives:[10]

    • To improve awareness and understanding of antimicrobial resistance
    • To strengthen surveillance and research
    • To reduce the incidence of infection
    • To optimize the use of antimicrobial medicines
    • To ensure sustainable investment in countering antimicrobial resistance.

    A political declaration endorsed by Heads of State at the United Nations General Assembly in New York in September 2016 signaled the world's commitment to taking a broad, coordinated approach to address the root causes of antimicrobial resistance across multiple sectors, especially human health, animal health, and agriculture. The WHO is supporting member states to develop national action plans on antimicrobial resistance, based on the global action plan.”

    We are expected to act responsibly as health providers.

      References Top

    Drisko CH. Nonsurgical periodontal therapy. Periodontol 2000 2001;25:77-88.  Back to cited text no. 1
    Jepsen S, Deschner J, Braun A, Schwarz F, Eberhard J. Calculus removal and the prevention of its formation. Periodontol 2000 2011;55:167-88.  Back to cited text no. 2
    Garcia Canas P, Khouly I, Sanz J, Loomer PM. Effectiveness of systemic antimicrobial therapy in combination with scaling and root planing in the treatment of periodontitis: A systematic review. J Am Dent Assoc 2015;146:150-63.  Back to cited text no. 3
    Mombelli A, Cionca N, Almaghlouth A. Does adjunctive antimicrobial therapy reduce the perceived need for periodontal surgery? Periodontol 2000 2011;55:205-16.  Back to cited text no. 4
    Guerrero A, Griffiths GS, Nibali L, Suvan J, Moles DR, Laurell L, et al. Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive periodontitis: A randomized placebo-controlled clinical trial. J Clin Periodontol 2005;32:1096-107.  Back to cited text no. 5
    Griffiths GS, Ayob R, Guerrero A, Nibali L, Suvan J, Moles DR, et al. Amoxicillin and metronidazole as an adjunctive treatment in generalized aggressive periodontitis at initial therapy or re-treatment: A randomized controlled clinical trial. J Clin Periodontol 2011;38:43-9.  Back to cited text no. 6
    Guzeldemir-Akcakanat E, Gurgan CA. Systemic moxifloxacin vs. amoxicillin/metronidazole adjunct to non-surgical treatment in generalized aggressive periodontitis. Med Oral Patol Oral Cir Bucal 2015;20:e441-9.  Back to cited text no. 7
    Jepsen K, Jepsen S. Antibiotics/antimicrobials: Systemic and local administration in the therapy of mild to moderately advanced periodontitis. Periodontol 2000 2016;71:82-112.  Back to cited text no. 8
    van Winkelhoff AJ, Herrera D, Oteo A, Sanz M. Antimicrobial profiles of periodontal pathogens isolated from periodontitis patients in the Netherlands and spain. J Clin Periodontol 2005;32:893-8.  Back to cited text no. 9
    World Health Organization Antibiotic Resistance. World Health Organization. Available from: https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance. [Last accessed on 2019 Sep 18].  Back to cited text no. 10


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