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Adjunctive effect of systemic antimicrobials in periodontitis therapy: A systematic review and meta‐analysis
Aim To answer the following PICOS questions: in patients with periodontitis, which is the efficacy of adjunctive systemic antimicrobials, in comparison with subgingival debridement plus a placebo, in terms of probing pocket depth (PPD) reduction, in randomized clinical trials with at least 6 months...
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| Published in: | Journal of clinical periodontology 2020-07, Vol.47 (S22), p.257-281 |
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| Main Authors: | , , , , , |
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| cites | cdi_FETCH-LOGICAL-c4594-5ea6242743d72c35fb0f1f7a4022606486eb2045912b8276cce59f4d9c6edd823 |
| container_end_page | 281 |
| container_issue | S22 |
| container_start_page | 257 |
| container_title | Journal of clinical periodontology |
| container_volume | 47 |
| creator | Teughels, Wim Feres, Magda Oud, Valerie Martín, Conchita Matesanz, Paula Herrera, David |
| description | Aim
To answer the following PICOS questions: in patients with periodontitis, which is the efficacy of adjunctive systemic antimicrobials, in comparison with subgingival debridement plus a placebo, in terms of probing pocket depth (PPD) reduction, in randomized clinical trials with at least 6 months of follow‐up?
Material and Methods
A systematic search was conducted: 34 articles (28 studies) were included. Data on clinical outcome variables changes were pooled and analysed using weighted mean differences (WMDs), 95% confidence intervals (CI) and prediction intervals (PIs), in case of significant heterogeneity.
Results
For PPD, statistically significant benefits (p |
| doi_str_mv | 10.1111/jcpe.13264 |
| format | article |
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To answer the following PICOS questions: in patients with periodontitis, which is the efficacy of adjunctive systemic antimicrobials, in comparison with subgingival debridement plus a placebo, in terms of probing pocket depth (PPD) reduction, in randomized clinical trials with at least 6 months of follow‐up?
Material and Methods
A systematic search was conducted: 34 articles (28 studies) were included. Data on clinical outcome variables changes were pooled and analysed using weighted mean differences (WMDs), 95% confidence intervals (CI) and prediction intervals (PIs), in case of significant heterogeneity.
Results
For PPD, statistically significant benefits (p < .001) were observed in short‐term studies (WMD = 0.448, 95% CI [0.324; 0.573], PI [−0.10 to 0.99]) and long‐term studies (WMD = 0.485, 95% CI [0.322; 0.648], PI [−0.11 to 1.08]). Additionally, statistically significant benefits were also found for clinical attachment level, bleeding on probing, pocket closure and frequency of residual pockets. The best outcomes were observed for the combination of amoxicillin plus metronidazole, followed by metronidazole alone and azithromycin. Adverse events were more frequently reported in groups using systemic antimicrobials.
Conclusions
The adjunctive use of systemic antimicrobials in periodontal therapy results in statistically significant benefits in clinical outcomes, with more frequent adverse events in test groups using systemic antimicrobials.</description><identifier>ISSN: 0303-6979</identifier><identifier>EISSN: 1600-051X</identifier><identifier>DOI: 10.1111/jcpe.13264</identifier><identifier>PMID: 31994207</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Amoxicillin ; Amoxicillin - therapeutic use ; Anti-Bacterial Agents - therapeutic use ; Anti-Infective Agents - therapeutic use ; Antimicrobial agents ; Azithromycin ; Clinical trials ; Dental Scaling ; Dentistry ; Gum disease ; Humans ; Meta-analysis ; Metronidazole ; Metronidazole - therapeutic use ; Periodontitis ; Periodontitis - drug therapy ; Root Planing ; scaling and root planing ; Statistical analysis ; systematic review ; systemic antimicrobials</subject><ispartof>Journal of clinical periodontology, 2020-07, Vol.47 (S22), p.257-281</ispartof><rights>2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd</rights><rights>2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2020 John Wiley & Sons A/S</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4594-5ea6242743d72c35fb0f1f7a4022606486eb2045912b8276cce59f4d9c6edd823</citedby><cites>FETCH-LOGICAL-c4594-5ea6242743d72c35fb0f1f7a4022606486eb2045912b8276cce59f4d9c6edd823</cites><orcidid>0000-0002-5554-2777 ; 0000-0002-5276-3689 ; 0000-0002-2293-3392 ; 0000-0001-7675-5643 ; 0000-0003-3997-6900 ; 0000-0001-9965-5768</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27900,27901</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31994207$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Teughels, Wim</creatorcontrib><creatorcontrib>Feres, Magda</creatorcontrib><creatorcontrib>Oud, Valerie</creatorcontrib><creatorcontrib>Martín, Conchita</creatorcontrib><creatorcontrib>Matesanz, Paula</creatorcontrib><creatorcontrib>Herrera, David</creatorcontrib><title>Adjunctive effect of systemic antimicrobials in periodontitis therapy: A systematic review and meta‐analysis</title><title>Journal of clinical periodontology</title><addtitle>J Clin Periodontol</addtitle><description>Aim
To answer the following PICOS questions: in patients with periodontitis, which is the efficacy of adjunctive systemic antimicrobials, in comparison with subgingival debridement plus a placebo, in terms of probing pocket depth (PPD) reduction, in randomized clinical trials with at least 6 months of follow‐up?
Material and Methods
A systematic search was conducted: 34 articles (28 studies) were included. Data on clinical outcome variables changes were pooled and analysed using weighted mean differences (WMDs), 95% confidence intervals (CI) and prediction intervals (PIs), in case of significant heterogeneity.
Results
For PPD, statistically significant benefits (p < .001) were observed in short‐term studies (WMD = 0.448, 95% CI [0.324; 0.573], PI [−0.10 to 0.99]) and long‐term studies (WMD = 0.485, 95% CI [0.322; 0.648], PI [−0.11 to 1.08]). Additionally, statistically significant benefits were also found for clinical attachment level, bleeding on probing, pocket closure and frequency of residual pockets. The best outcomes were observed for the combination of amoxicillin plus metronidazole, followed by metronidazole alone and azithromycin. Adverse events were more frequently reported in groups using systemic antimicrobials.
Conclusions
The adjunctive use of systemic antimicrobials in periodontal therapy results in statistically significant benefits in clinical outcomes, with more frequent adverse events in test groups using systemic antimicrobials.</description><subject>Amoxicillin</subject><subject>Amoxicillin - therapeutic use</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Anti-Infective Agents - therapeutic use</subject><subject>Antimicrobial agents</subject><subject>Azithromycin</subject><subject>Clinical trials</subject><subject>Dental Scaling</subject><subject>Dentistry</subject><subject>Gum disease</subject><subject>Humans</subject><subject>Meta-analysis</subject><subject>Metronidazole</subject><subject>Metronidazole - therapeutic use</subject><subject>Periodontitis</subject><subject>Periodontitis - drug therapy</subject><subject>Root Planing</subject><subject>scaling and root planing</subject><subject>Statistical analysis</subject><subject>systematic review</subject><subject>systemic antimicrobials</subject><issn>0303-6979</issn><issn>1600-051X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kU1LHTEUhoNU9Fa76Q-QQDdSGM3XZG7cXS7aDwRdKHQ3ZDInNMN8mWSU2fkT-hv9JY2d2y5cNJsD4XkfDudF6CMlZzS988aMcEY5k2IPragkJCM5_fEOrQgnPJOqUIfofQgNIbTgnB-gQ06VEowUK9Rv6mbqTXSPgMFaMBEPFoc5ROicwbqPLk0_VE63Absej-DdUA_pP7qA40_wepwv8GaX0TGlPDw6eErhGncQ9cvzL93rdg4uHKN9m0TwYTeP0P3V5d32a3Z98-XbdnOdGZErkeWgJROsELwumOG5rYilttCCMCaJFGsJFSMJpaxas0IaA7myolZGQl2vGT9Cp4t39MPDBCGWnQsG2lb3MEyhZFwkigpFEvrpDdoMk0_7JiqtwFhBqEjU54VKtwjBgy1H7zrt55KS8rWF8rWF8k8LCT7ZKaeqg_of-vfsCaAL8ORamP-jKr9vby8X6W93qZOQ</recordid><startdate>202007</startdate><enddate>202007</enddate><creator>Teughels, Wim</creator><creator>Feres, Magda</creator><creator>Oud, Valerie</creator><creator>Martín, Conchita</creator><creator>Matesanz, Paula</creator><creator>Herrera, David</creator><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5554-2777</orcidid><orcidid>https://orcid.org/0000-0002-5276-3689</orcidid><orcidid>https://orcid.org/0000-0002-2293-3392</orcidid><orcidid>https://orcid.org/0000-0001-7675-5643</orcidid><orcidid>https://orcid.org/0000-0003-3997-6900</orcidid><orcidid>https://orcid.org/0000-0001-9965-5768</orcidid></search><sort><creationdate>202007</creationdate><title>Adjunctive effect of systemic antimicrobials in periodontitis therapy: A systematic review and meta‐analysis</title><author>Teughels, Wim ; Feres, Magda ; Oud, Valerie ; Martín, Conchita ; Matesanz, Paula ; Herrera, David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4594-5ea6242743d72c35fb0f1f7a4022606486eb2045912b8276cce59f4d9c6edd823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Amoxicillin</topic><topic>Amoxicillin - therapeutic use</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Anti-Infective Agents - therapeutic use</topic><topic>Antimicrobial agents</topic><topic>Azithromycin</topic><topic>Clinical trials</topic><topic>Dental Scaling</topic><topic>Dentistry</topic><topic>Gum disease</topic><topic>Humans</topic><topic>Meta-analysis</topic><topic>Metronidazole</topic><topic>Metronidazole - therapeutic use</topic><topic>Periodontitis</topic><topic>Periodontitis - drug therapy</topic><topic>Root Planing</topic><topic>scaling and root planing</topic><topic>Statistical analysis</topic><topic>systematic review</topic><topic>systemic antimicrobials</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Teughels, Wim</creatorcontrib><creatorcontrib>Feres, Magda</creatorcontrib><creatorcontrib>Oud, Valerie</creatorcontrib><creatorcontrib>Martín, Conchita</creatorcontrib><creatorcontrib>Matesanz, Paula</creatorcontrib><creatorcontrib>Herrera, David</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical periodontology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Teughels, Wim</au><au>Feres, Magda</au><au>Oud, Valerie</au><au>Martín, Conchita</au><au>Matesanz, Paula</au><au>Herrera, David</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adjunctive effect of systemic antimicrobials in periodontitis therapy: A systematic review and meta‐analysis</atitle><jtitle>Journal of clinical periodontology</jtitle><addtitle>J Clin Periodontol</addtitle><date>2020-07</date><risdate>2020</risdate><volume>47</volume><issue>S22</issue><spage>257</spage><epage>281</epage><pages>257-281</pages><issn>0303-6979</issn><eissn>1600-051X</eissn><abstract>Aim
To answer the following PICOS questions: in patients with periodontitis, which is the efficacy of adjunctive systemic antimicrobials, in comparison with subgingival debridement plus a placebo, in terms of probing pocket depth (PPD) reduction, in randomized clinical trials with at least 6 months of follow‐up?
Material and Methods
A systematic search was conducted: 34 articles (28 studies) were included. Data on clinical outcome variables changes were pooled and analysed using weighted mean differences (WMDs), 95% confidence intervals (CI) and prediction intervals (PIs), in case of significant heterogeneity.
Results
For PPD, statistically significant benefits (p < .001) were observed in short‐term studies (WMD = 0.448, 95% CI [0.324; 0.573], PI [−0.10 to 0.99]) and long‐term studies (WMD = 0.485, 95% CI [0.322; 0.648], PI [−0.11 to 1.08]). Additionally, statistically significant benefits were also found for clinical attachment level, bleeding on probing, pocket closure and frequency of residual pockets. The best outcomes were observed for the combination of amoxicillin plus metronidazole, followed by metronidazole alone and azithromycin. Adverse events were more frequently reported in groups using systemic antimicrobials.
Conclusions
The adjunctive use of systemic antimicrobials in periodontal therapy results in statistically significant benefits in clinical outcomes, with more frequent adverse events in test groups using systemic antimicrobials.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>31994207</pmid><doi>10.1111/jcpe.13264</doi><tpages>25</tpages><orcidid>https://orcid.org/0000-0002-5554-2777</orcidid><orcidid>https://orcid.org/0000-0002-5276-3689</orcidid><orcidid>https://orcid.org/0000-0002-2293-3392</orcidid><orcidid>https://orcid.org/0000-0001-7675-5643</orcidid><orcidid>https://orcid.org/0000-0003-3997-6900</orcidid><orcidid>https://orcid.org/0000-0001-9965-5768</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of clinical periodontology, 2020-07, Vol.47 (S22), p.257-281 |
| issn | 0303-6979 1600-051X |
| language | eng |
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| source | Wiley-Blackwell Read & Publish Collection |
| subjects | Amoxicillin Amoxicillin - therapeutic use Anti-Bacterial Agents - therapeutic use Anti-Infective Agents - therapeutic use Antimicrobial agents Azithromycin Clinical trials Dental Scaling Dentistry Gum disease Humans Meta-analysis Metronidazole Metronidazole - therapeutic use Periodontitis Periodontitis - drug therapy Root Planing scaling and root planing Statistical analysis systematic review systemic antimicrobials |
| title | Adjunctive effect of systemic antimicrobials in periodontitis therapy: A systematic review and meta‐analysis |
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