Department of Periodontology, School of Dentistry, Rio de Janeiro State University, Brazil.
Department of Community and Preventive Dentistry, School of Dentistry, Rio de Janeiro State University, Brazil.
J Dent. 2017 Nov;66:1-7. doi: 10.1016/j.jdent.2017.08.001. Epub 2017 Aug 4.
To assess the effects of adjunctive use of systemic antibiotics in nonsurgical periodontal treatment compared to nonsurgical periodontal treatment alone, on mean glycated hemoglobin (HbA1c) reductions in patients with diabetes.
Two independent reviewers screened six electronic databases, registers of clinical trials, meeting abstracts and four major dental journals for controlled clinical trials with at least 3-month follow-up.
After duplicates removal, electronic and hand searches yielded 2136 records; 32 full-text articles were independently read by two reviewers. To evaluate the additional effect of antibiotic usage, pooled weighted mean differences and 95% confidence intervals were calculated using fixed and random effects models.
Twelve studies met the inclusion criteria, nine of which provided data that allowed their inclusion in meta-analyses. The meta-analyses showed no significant effect favouring scaling and root planing (SRP) plus antibiotic for reductions in mean HbA1c (-0.11% [-0.35, 0.13]; 6 studies), and an estimated prediction interval varying from -0.45 to 0.23. There was also no significant effect favouring the adjunctive usage of sub-antimicrobial doxycycline in HbA1c mean reduction (-0.19% [-1.04, 0.67]; 2 studies).
Adjunctive use of systemic antibiotic provides no statistically significant benefit in terms of HbA1c improvement in periodontal treatment of patients with diabetes.
Adjunctive use of systemic antibiotics associated with nonsurgical periodontal treatment provides no additional benefit in terms of HbA1c of diabetic patients. Clinicians should weigh the trade-off between risks and benefits provided by the use of systemic antibiotics before prescribing them for periodontal disease treatment.
评估在非手术牙周治疗中辅助使用全身抗生素与单纯非手术牙周治疗相比，对糖尿病患者糖化血红蛋白（HbA1c）平均降低的影响。
两名独立评审员筛选了六个电子数据库、临床试验注册处、会议摘要和四份主要牙科期刊中至少有 3 个月随访的对照临床试验。
去除重复项后，电子和手工搜索产生了 2136 条记录；两名评审员独立阅读了 32 篇全文文章。为了评估抗生素使用的额外效果，使用固定和随机效应模型计算了加权均数差值和 95%置信区间的合并。
符合纳入标准的 12 项研究，其中 9 项提供的数据允许纳入荟萃分析。荟萃分析显示，在糖化血红蛋白（HbA1c）平均降低方面，牙周洁治术（SRP）加抗生素治疗没有显著效果（-0.11%[-0.35，0.13]；6 项研究），估计预测区间在-0.45 到 0.23 之间。在辅助使用亚抗菌剂量的强力霉素对 HbA1c 平均降低方面也没有显著效果（-0.19%[-1.04，0.67]；2 项研究）。
辅助使用全身抗生素在改善糖尿病患者牙周治疗的糖化血红蛋白方面没有统计学上的显著益处。
在非手术牙周治疗中辅助使用全身抗生素，对糖尿病患者的糖化血红蛋白没有额外的益处。临床医生在为牙周病治疗开处方时，应权衡使用全身抗生素的风险和益处之间的权衡。
