Shaping the Indications for Periodontal Adjunctive Antibiotics in Dental Practice: A PBRN Clinical Trial

牙周辅助抗生素在牙科实践中的适应症：PBRN临床试验 牙周炎是一种细菌性炎症性疾病，据报道，影响近40%的美国人 年龄在30岁或以上。如果不及时治疗，牙周炎可导致牙齿脱落和患者感知的发病率。 从历史上看，抗生素的使用一直是牙周病治疗的一个组成部分。然而，抗生素 管理要求合理化他们的处方，以减少抗生素滥用和耐药性的发展， 菌株在整个医学学科中，有一个明确的方向来识别实际上可能受益的个人 抗生素的使用，并提供其使用指南。截至2018年，美国牙科协会 制定循证指南，限制牙科预防性使用抗生素的情况 实践;然而，没有国家指南存在抗生素用于治疗牙周感染 因为缺乏足够的试验评估疾病和个人的具体适应症。因此，在本发明中， 牙医可以决定何时使用抗生素，哪些牙科患者需要使用抗生素。 实现牙周健康。在牙周炎治疗的背景下，存在生物学原理来支持 抗生素对牙周致病菌的预防性使用，但其使用的临床结果 结果相互矛盾。目前，关于处方模式和使用情况的文件非常有限 抗生素作为牙周治疗药物在美国从业者中存在。然而，数据来自 学术研究表明，连续的全身性抗生素可能只对某些人群有益， 因为对治疗的生物反应在个体之间是高度可变的。这种显著的变化性保证了 确定与最大受益相关的个人和/或疾病特征， 抗生素连续治疗。因此，可以制定明确的指导方针， 它们的使用适应症，最终目标是最大限度地减少牙周治疗中的抗生素滥用， 避免产生抗生素耐药性。本研究的目的是评估 阿莫西林/甲硝唑联合抗生素在牙周非手术治疗中的应用 在国家牙科PBRN内进行最大的随机临床试验（RCT）， 辅助抗生素。此外，在本PBRN研究中，目前的决策因素， 并会调查抗生素处方，以评估临床情况。重要的是， 利用功效良好的RCT数据集，将确定对抗生素治疗的高应答者 并将评估临床医生目前采用的决策因素的预测有效性， 制定明确的处方适应症。总的来说，目前预防性使用抗生素的结果是 由于适应症是基于经验信息而没有循证指南， 这可能导致抗生素滥用和缺乏疗效。目前实用性强的RCT是 旨在为牙周预防性抗生素的使用制定循证指南。

Shaping the Indications for Periodontal Adjunctive Antibiotics in dental practice: A PBRN Clinical Trial Periodontitis is a bacterial inflammatory disease that has been reported to affect nearly 40% of Americans aged 30 years or older. If left untreated, periodontitis can lead to tooth loss and patient-perceived morbidity. Historically, antibiotic use has been an integral part of periodontal disease treatment. However, antibiotic stewardship calls for rationalizing their prescription to reduce antibiotic misuse and development of resistant strains. Across medical disciplines, there is a clear direction to identify individuals who in fact may benefit from antibiotic use and to provide guidelines for their use. As of 2018, the American Dental Association has developed evidence-based guidelines limiting circumstances for prophylactic antibiotic use in dental practice; however, no national guidelines exist for antibiotic use in treatment of periodontal infections because of lack of adequately powered trials assessing disease- and person-specific indications. Thus, dentists are left to decide when adjunctive antibiotics are indicated, and which dental patients need them to achieve periodontal health. In the context of periodontitis treatment, a biological rationale exists to support adjunctive antibiotic use against periodontal pathogenic bacteria, but clinical results of their use have presented conflicting results. Currently, very limited documentation of the prescription patterns and utilization of antibiotics as periodontal treatment adjuncts among US practitioners exist. Nonetheless, data from academic studies suggest that adjunctive systemic antibiotics may only be beneficial for certain populations, as the biological response to treatment is highly variable across individuals. This marked variability warrants the identification of person- and/or disease-related characteristics that are linked to maximum benefit from adjunctive antibiotic treatment. Consequently, clear guidelines can then be established for tailored indications for their use with the ultimate goal of minimizing antibiotic misuse in periodontal treatment to avoid development of antibiotic resistance. The objective of this study is to assess the effectiveness of adjunctive Amoxicillin/Metronidazole combination antibiotics to non-surgical periodontal therapy in clinical practices within the National Dental PBRN by conducting the largest randomized clinical trial (RCT) of adjunctive antibiotics. Further, within this PBRN study, current decision-making factors for adjunctive antibiotic prescription will be surveyed to assess the state of affairs in clinical practice. Importantly, leveraging the well-powered RCT dataset, high responders to adjunctive antibiotic treatment will be identified and the predictive validity of decision-making factors currently employed by clinicians will be assessed to develop clear indications for prescription. Collectively, results of adjunctive antibiotic use at present are ambiguous because indications are based on empirical information without evidence-based guidelines, which may lead to antibiotic misuse and lack of efficacy. The present pragmatic well-powered RCT was designed to enable the development of evidence-based guidelines for periodontal adjunctive antibiotic use.