Atieh M A, Shah M, Hakam A, Alghafri M, Tawse-Smith A, Alsabeeha Nhm
Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates.
Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
Aust Dent J. 2024 Mar;69(1):4-17. doi: 10.1111/adj.12991. Epub 2023 Oct 24.
The use of systemic azithromycin (AZT) and amoxicillin/metronidazole (AMX/MTZ) as adjuncts provided additional clinical and microbiological benefits over subgingival instrumentation alone. However, the superiority of one antibiotic regimen over another has not been proven. Therefore, the aim of this systematic review and meta-analyses was to evaluate the clinical efficacy and safety of subgingival instrumentation (SI) in conjunction with the systemic use of AZT or AMX/MTZ for the treatment of periodontitis from current published literature.
Electronic databases were searched to identify randomized controlled trials (RCTs), controlled clinical trials, prospective and retrospective human studies that compared the adjunctive use of systemic AZT to AMX/MTZ with SI in the treatment of periodontitis. The eligibility criteria were defined based on the participant (who had periodontitis), intervention (SI with adjunctive use of systemic AZT), comparison (SI with adjunctive use of systemic AMX/MTZ), outcomes (primary outcome: changes in probing pocket). The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Data were analysed using a statistical software program.
Five studies with 151 participants with periodontitis were included in the present review. Of these, 74 participants received adjunctive AZT, while the remaining participants received AMX/MTZ as an adjunct to SI. The adjunctive use of AZT and AMX/MTZ had comparable changes in probing pocket depths at 1-3 months with no statistically significant difference (mean difference (MD) 0.01; 95% CI -0.20 to 0.22; P = 0.94). The adjunctive use of AZT had significantly fewer number of residual sites with probing pocket depths of ≥5 mm at 1-3 months compared to the adjunctive use of AMX/MTZ (MD -3.41; 95% CI -4.73 to -2.10; P < 0.0001). The prevalence rates of adverse events among participants who received AZT and AMX/MTZ were 9.80% and 14.8%, respectively. The meta-analysis showed that the difference between the two groups was not statistically significant (risk ratio 0.69; 95% CI 0.28 to 1.72; P = 0.43).
Within the limitation of this review, there was no superiority between AZT and AMX/MTZ in terms of mean changes in probing pocket depths, clinical attachment level, bleeding on probing at 1-3 months. AZT seem to be associated with less sites with residual probing pocket depths of ≥5 mm at 1-3 months and fewer adverse events compared with AMX/MTZ. © 2023 Australian Dental Association.
全身使用阿奇霉素（AZT）和阿莫西林/甲硝唑（AMX/MTZ）作为辅助治疗手段，相较于单纯的龈下器械治疗，能带来额外的临床和微生物学益处。然而，一种抗生素治疗方案优于另一种的优势尚未得到证实。因此，本系统评价和荟萃分析的目的是从当前已发表的文献中评估龈下器械治疗（SI）联合全身使用AZT或AMX/MTZ治疗牙周炎的临床疗效和安全性。
检索电子数据库，以识别比较全身使用AZT与AMX/MTZ联合SI治疗牙周炎的随机对照试验（RCT）、对照临床试验、前瞻性和回顾性人体研究。根据参与者（患有牙周炎）、干预措施（SI联合全身使用AZT）、对照（SI联合全身使用AMX/MTZ）、结局指标（主要结局指标：探诊深度变化）来定义纳入标准。使用Cochrane协作网的偏倚风险工具评估偏倚风险。使用统计软件程序分析数据。
本评价纳入了5项研究，共151名患有牙周炎的参与者。其中，74名参与者接受了AZT辅助治疗，其余参与者接受AMX/MTZ作为SI的辅助治疗。在1至3个月时，AZT和AMX/MTZ辅助治疗的探诊深度变化相当，无统计学显著差异（平均差（MD）0.01；95%置信区间 -0.20至0.22；P = 0.94）。与AMX/MTZ辅助治疗相比，AZT辅助治疗在1至3个月时探诊深度≥5 mm的残留部位数量显著更少（MD -3.41；95%置信区间 -4.73至 -2.10；P < 0.0001）。接受AZT和AMX/MTZ治疗的参与者中不良事件的发生率分别为9.80%和14.8%。荟萃分析表明，两组之间的差异无统计学意义（风险比0.69；95%置信区间0.28至1.72；P = 0.43）。
在本评价的局限性范围内，在1至3个月时，AZT和AMX/MTZ在探诊深度平均变化、临床附着水平、探诊出血方面没有优势。与AMX/MTZ相比，AZT似乎与1至3个月时探诊深度≥5 mm的残留部位较少以及不良事件较少相关。© 2023澳大利亚牙科协会。
