Systemic Anti-Infective Periodontal Therapy. A Systematic Review

Abstract

Background: Periodontal diseases are infections and thus systemically administered antibiotics are often employed as adjuncts for their control. There are conflicting reports as to whether these agents provide a therapeutic benefit.

Rationale:The purpose of this systematic review is to determine whether systemically administered antibiotics improve a primary clinical outcome measure, periodontal attachment level change.

Focused Question: In patients with periodontitis, what is the effect of systemically administered antibiotics as compared to controls on clinical measures of attachment level?

Search Protocol:The PubMed database was searched from 1966 to May 2002. Searches were limited to human studies published in English. Hand searches were performed on the Journal of Clinical Periodontology, Journal of Periodontology, and Journal of Periodontal Research. References in relevant papers and review articles were also examined.

Selection Criteria

Inclusion criteria: Trials were selected if they met the following criteria: randomized controlled clinical trials, quasi-experimental studies, and cohort studies of >1 month duration with a comparison group; subjects with aggressive, chronic, or recurrent periodontitis and periodontal abscess; use of a single or a combination of systemically administered antibiotics(s) versus non-antibiotic therapy; and a primary outcome of mean attachment level change (AL).

Exclusion criteria: Studies involving the use of low-dose doxyclycline, combinations of locally plus systemic antibiotics, or where the control group included a systemically administered antibiotic were excluded.

Data Collection and Analysis: A mean difference in AL between groups was available for all papers used in the meta-analysis. A standard deviation (SD) for the difference was used if provided or calculated from the SD or standard error of the mean (SEM) when provided for single measurements. Data were subset by antibiotic employed, type of adjunctive therapy, and disease type. Results were assessed with both fixed-effects and random-effects models.

Ann Periodontol 2003;8:115-181.