Systemic azithromycin versus amoxicillin/metronidazole as an adjunct in the treatment of periodontitis: a systematic review and meta-analysis

IF 1.9 4区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Australian dental journal Pub Date : 2023-10-24 DOI:10.1111/adj.12991

MA Atieh, M Shah, A Hakam, M Alghafri, A Tawse-Smith, NHM Alsabeeha

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引用次数: 0

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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全身性阿奇霉素与阿莫西林/甲硝唑作为治疗牙周炎的辅助药物:一项系统综述和荟萃分析。

背景：与单独使用龈下器械相比，使用系统性阿奇霉素（AZT）和阿莫西林/甲硝唑（AMX/MTZ）作为佐剂提供了额外的临床和微生物益处。然而，一种抗生素方案相对于另一种方案的优越性尚未得到证实。因此，本系统综述和荟萃分析的目的是从当前发表的文献中评估龈下器械（SI）与AZT或AMX/MTZ治疗牙周炎的临床疗效和安全性。方法：检索电子数据库，以确定随机对照试验（RCT）、对照临床试验、前瞻性和回顾性人类研究，这些研究比较了系统性AZT、AMX/MTZ和SI在治疗牙周炎中的辅助使用。资格标准是根据参与者（患有牙周炎）、干预（辅助使用全身AZT的SI）、比较（辅助使用系统AMX/MTZ的SI）和结果（主要结果：探测袋的变化）来确定的。使用Cochrane协作的偏倚风险工具评估偏倚风险。使用统计软件程序对数据进行分析。结果：本综述包括5项研究，共151名牙周炎患者。其中，74名参与者接受了辅助AZT，其余参与者接受了AMX/MTZ作为SI的辅助。辅助使用AZT和AMX/MTZ在1-3时的探测袋深度变化相当月，无统计学显著差异（平均差异（MD）0.01；95%置信区间-0.20至0.22；P = 0.94）。辅助使用AZT的探测袋深度≥5的残留位点数量显著减少 1-3时为mm 月与AMX/MTZ的辅助使用相比（MD-3.41；95%CI-4.73至-2.10；P 结论：在本综述的范围内，AZT和AMX/MTZ在探测袋深度、临床附着水平、1-3时探测出血的平均变化方面没有优势月。AZT似乎与残余探测袋深度≥5的较少部位有关 1-3时为mm 与AMX/MTZ相比，不良事件更少。©2023澳大利亚牙科协会。

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来源期刊

Australian dental journal 医学-牙科与口腔外科

CiteScore

4.20

自引率

4.80%

发文量

审稿时长

6-12 weeks

期刊介绍： The Australian Dental Journal provides a forum for the exchange of information about new and significant research in dentistry, promoting the discipline of dentistry in Australia and throughout the world. It comprises peer-reviewed research articles as its core material, supplemented by reviews, theoretical articles, special features and commentaries.