Department of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland.
J Periodontol. 2013 Jun;84(6):715-24. doi: 10.1902/jop.2012.120281. Epub 2012 Aug 8.
It has been suggested that prescription of amoxicillin plus metronidazole in the context of periodontal therapy should be limited to patients with specific microbiologic profiles, especially those testing positive for Aggregatibacter actinomycetemcomitans. The main purpose of this analysis is to determine if patients positive for A. actinomycetemcomitans with moderate to advanced periodontitis benefit specifically from amoxicillin plus metronidazole given as an adjunct to full-mouth scaling and root planing.
This is a double-masked, placebo-controlled, randomized longitudinal study including 41 participants who were positive for A. actinomycetemcomitans and 41 participants who were negative for A. actinomycetemcomitans. All 82 patients received full-mouth periodontal debridement performed within 48 hours. Patients then received either systemic antibiotics (375 mg amoxicillin and 500 mg metronidazole, three times daily) or placebo for 7 days. The primary outcome variable was persistence of sites with a probing depth (PD) >4 mm and bleeding on probing (BOP) at the 3-month reevaluation. Using multilevel logistic regression, the effect of the antibiotics was analyzed according to the following factors (interaction effect): A. actinomycetemcomitans-positive or -negative at baseline, sex, age, smoking, tooth being a molar, and interdental location.
At reevaluation, participants in the test group had significantly fewer sites with a persisting PD >4 mm and BOP than control patients (P <0.01). Being A. actinomycetemcomitans-positive or -negative did not change the effect of the antibiotics. Patients benefited from the antibiotics irrespective of sex, age, or smoking status. Molars benefited significantly more from the antibiotics than non-molars (P for interaction effect = 0.03).
Patients who were positive for A. actinomycetemcomitans had no specific benefit from amoxicillin plus metronidazole. Sites on molars benefited significantly more from the antibiotics than non-molar sites.
有人认为，在牙周治疗中，阿莫西林加甲硝唑的处方应仅限于具有特定微生物特征的患者，特别是那些对伴放线放线杆菌检测呈阳性的患者。本分析的主要目的是确定患有中重度牙周炎且伴放线放线杆菌呈阳性的患者是否特别受益于阿莫西林加甲硝唑辅助全口牙周洁治和根面平整。
这是一项双盲、安慰剂对照、随机纵向研究，共纳入 41 名伴放线放线杆菌阳性患者和 41 名伴放线放线杆菌阴性患者。所有 82 名患者均在 48 小时内接受全口牙周清创术。随后，患者接受为期 7 天的全身抗生素（375mg 阿莫西林和 500mg 甲硝唑，每日三次）或安慰剂治疗。主要结局变量是在 3 个月复查时探诊深度（PD）>4mm 和探诊出血（BOP）的部位是否持续存在。采用多水平逻辑回归，根据以下因素（交互作用）分析抗生素的效果：基线时伴放线放线杆菌阳性或阴性、性别、年龄、吸烟、牙齿为磨牙以及牙间隙位置。
在复查时，试验组的患者与对照组患者相比，持续存在 PD>4mm 和 BOP 的部位明显减少（P<0.01）。伴放线放线杆菌阳性或阴性并未改变抗生素的效果。无论性别、年龄或吸烟状况如何，患者均从抗生素中受益。磨牙从抗生素中获益明显多于非磨牙（交互作用效应 P 值=0.03）。
伴放线放线杆菌阳性的患者从阿莫西林加甲硝唑中获益无明显差异。磨牙位点从抗生素中获益明显多于非磨牙位点。
