Department of Periodontology, School of Dental Medicine, University of Geneva, Rue Barthélemy-Menn 19, CH-1205 Geneva, Switzerland.
J Periodontol. 2010 Jan;81(1):15-23. doi: 10.1902/jop.2009.090390.
It has been suggested that use of systemic antibiotics should be limited to patients with specific microbiologic profiles. The main purpose of the present analysis was to study whether microbiologic testing before therapy was of value in predicting which patients would specifically benefit from adjunctive amoxicillin and metronidazole, given in the context of full-mouth scaling and root planing (SRP) within 48 hours.
This was a 6-month, single-center, double-masked, placebo-controlled, randomized longitudinal study. Fifty-one patients received full-mouth periodontal debridement, performed within 48 hours; then, 25 subjects received metronidazole, 500 mg, and amoxicillin, 375 mg, three times a day for 7 days, and 26 received a placebo (control group). Pooled microbiologic samples were taken from the deepest pocket at baseline in each quadrant before and 6 months after treatment. Six periodontal pathogens were quantified by real-time polymerase chain reaction.
Forty-seven patients were followed for 6 months. After treatment, test subjects had a substantially lower mean number of persisting sites with probing depth >4 mm and bleeding on probing than did control subjects (0.4 versus 3.0; P = 0.005; month 6). Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans) could not be detected in the antibiotic group after treatment. However, in the placebo group, three of six subjects positive for A. actinomycetemcomitans continued to be positive. Lower frequencies were also noted in the test group for Porphyromonas gingivalis (P = 0.013) and Tannerella forsythia (previously T. forsythensis) (P = 0.007). However, even subjects testing negative for A. actinomycetemcomitans at baseline had a significantly better primary clinical outcome if they received the active drugs. The presence of six putative periodontal pathogens (A. actinomycetemcomitans, Fusobacterium nucleatum spp., P. gingivalis, Prevotella intermedia, Treponema denticola, and T. forsythia) quantified prior to therapy was not correlated with the outcome of full-mouth SRP with or without amoxicillin and metronidazole.
Excellent clinical results in the antibiotics group were obtained regardless of the presence or absence of six classic periodontal periopathogens prior to treatment.
有人认为，应将全身用抗生素的使用限于具有特定微生物特征的患者。本分析的主要目的是研究在接受全口牙周刮治和根面平整（SRP）后 48 小时内，是否在治疗前进行微生物检测有助于预测哪些患者将特别受益于辅助使用阿莫西林和甲硝唑。
这是一项为期 6 个月的、单中心、双盲、安慰剂对照、随机纵向研究。51 例患者在 48 小时内接受全口牙周清创术，然后 25 例患者接受甲硝唑 500mg 和阿莫西林 375mg，每日 3 次，共 7 天，26 例患者接受安慰剂（对照组）。在治疗前和治疗后 6 个月，从每个象限的最深口袋中采集混合微生物样本。通过实时聚合酶链反应定量 6 种牙周病原体。
47 例患者随访 6 个月。治疗后，试验组与对照组相比，持续存在探诊深度>4mm 和探诊出血的位点数量显著减少（0.4 与 3.0；P=0.005；6 个月）。治疗后，抗生素组中无法检测到伴放线放线杆菌（以前称为放线杆菌 actinomycetemcomitans）。然而，在安慰剂组中，6 例阳性伴放线放线杆菌中有 3 例仍为阳性。试验组中牙龈卟啉单胞菌（P=0.013）和福赛坦纳菌（以前称为福赛坦纳菌）（P=0.007）的检出频率也较低。然而，即使在基线时检测不到伴放线放线杆菌的患者，如果使用活性药物，其主要临床结局也显著改善。在接受全口 SRP 治疗时，治疗前存在六种潜在牙周病原菌（伴放线放线杆菌、核梭杆菌 spp.、牙龈卟啉单胞菌、中间普氏菌、齿密螺旋体和福赛坦纳菌）与阿莫西林和甲硝唑的治疗效果无关。
无论在治疗前是否存在六种经典牙周病原体，抗生素组都能获得出色的临床效果。
