The use of metronidazole and amoxicillin in the treatment of advanced periodontal disease - A prospective, controlled clinical trial
The use of metronidazole and amoxicillin in the treatment of advanced periodontal disease - A prospective, controlled clinical trial
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DOI：
10.1111/j.1600-051x.1998.tb02455.x
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发表时间：
1998-05-01
影响因子：
6.7
通讯作者：
Lindhe, J
中科院分区：
文献类型：
--
作者：
Berglundh, T;Krok, L;Lindhe, J
目前的临床试验进行研究的影响，全身管理甲硝唑和阿莫西林作为辅助机械治疗晚期牙周病患者。入选16例晚期牙周病患者，其中女性10例，男性6例，年龄35-58岁。基线检查包括评估牙周病的临床、放射学、微生物和组织病理学特征。将16名患者随机分配到2个不同的样本中，每个样本8名受试者。一份受试者样本在积极牙周治疗的前2周内接受了通过全身途径给予的抗生素（甲硝唑和阿莫西林）。在相应期间，第2份受试者样本接受安慰剂药物（安慰剂样本）。在16名患者中，每个患者的2个象限（1个在上颌骨和1个在下颌骨）暴露于非手术龈下刮治和根面平整。对侧象限不使用龈下器械。因此，形成4个不同的治疗组;组1：抗生素治疗但不刮治，组2：抗生素治疗加刮治，组3：安慰剂治疗但不刮治，组4：安慰剂治疗加刮治。进行有关临床参数的复查，在完成活性治疗后2个月和12个月，采集龈下微生物群样品，并从1个缩放象限和1个非缩放象限获得1个软组织活检。第1组和第3组中的牙齿在12个月的检查后接受非手术牙周治疗，随后退出研究。第2组和第4组也在基线后24个月重新检查。研究结果表明，在晚期牙周病患者中，甲硝唑联合阿莫西林全身给药导致（i）牙周状况的改善，（ii）消除/抑制假定的牙周病原体，如A.放线菌共生菌、牙龈卟啉单胞菌、中间卟啉单胞菌和（iii）减少炎性病变的大小。然而，单独的抗生素方案在减少BoP阳性位点、探测囊袋深度减少、探测附着增加方面不如机械治疗有效。在改善牙周病的临床和微生物学特征方面，机械和全身抗生素联合治疗（第2组）比单独机械治疗更有效。
The present clinical trial was performed to study the effect of systemic administration of metronidazole and amoxicillin as an adjunct to mechanical therapy in patients with advanced periodontal disease. 16 individuals, 10 female and 6 male, aged 35-58 years, with advanced periodontal disease were recruited. A baseline examination included assessment of clinical, radiographical, microbiological and histopathological characteristics of periodontal disease. The 16 patients were randomly distributed into 2 different samples of 8 subjects each. One sample of subjects received during the first 2 weeks of active periodontal therapy, antibiotics administered via the systemic route (metronidazole and amoxicillin). During the corresponding period, the 2nd sample of subjects received a placebo drug (placebo sample). In each of the 16 patients, 2 quadrants (1 in the maxilla and 1 in the mandible) were exposed to non-surgical subgingival scaling and root planing. The contralateral quadrants were left without subgingival instrumentation. Thus, 4 different treatment groups were formed; group 1: antibiotic therapy but no scaling, group 2: antibiotic therapy plus scaling, group 3: placebo therapy but no scaling, group 4: placebo therapy plus scaling. Re-examinations regarding the clinical parameters were performed, samples of the subgingival microbiota harvested and 1 soft tissue biopsy from 1 scaled and 1 non-scaled quadrant obtained 2 months and 12 months after the completion of active therapy. The teeth included in groups 1 and 3 were following the 12-month examination exposed to non-surgical periodontal therapy, and subsequently exited from the study. Groups 2 and 4 were also re-examined 24 months after baseline. The findings demonstrated that in patients with advanced periodontal disease, systemic administration of metronidazole plus amoxicillin resulted in (i) an improvement of the periodontal conditions, (ii) elimination/suppression of putative periodontal pathogens such as A. actinomycetemcomitans, P. gingivalis, P. intermedia and (iii) reduction of the size of the inflammatory lesion. The antibiotic regimen alone, however, was less effective than mechanical therapy with respect to reduction of BoP - positive sites, probing pocket depth reduction, probing attachment gain. The combined mechanical and systemic antibiotic therapy (group 2) was more effective than mechanical therapy alone in terms of improvement of clinical and microbiological features of periodontal disease.