The use of systemic antibiotics in the treatment of refractory periodontitis
Kvaliteten af den samlede dokumentation tillader ikke den konklusion, at supplerende systemisk antibiotika i behandlingen af refraktær marginal parodontitis forøger effekten sammenlignet med konventionel mekanisk behandling alene.
Brugen af systemisk antibiotika i behandlingen af refraktær marginal parodontitis
Baggrund
– Målet med at behandle refraktær marginal parodontitis (RMP) er at standse eller reducere sygdomsudviklingen. Denne behandling har ofte anvendt systemisk antibiotikum som supplement til den konventionelle mekaniske behandling. Formålet med denne systematiske oversigt var at evaluere evidensen for, at systemisk anvendelse af antibiotikum som supplement til konventionel mekanisk behandling øger effekten af behandlingen af RMP.
Typer undersøgelser, som er inkluderet
– Forfatterne søgte efter studier i PubMed Medline, Cochrane Central Register of Controlled Trials, Thomson Reuters Web of Science, Scopus, Latin American and Caribbian Center on Health Sciences Information og Scientific Electronic Library Online elektroniske databaser ved hjælp af udvalgte emneord fra de tidligste registreringer og op til den 31. oktober 2014. Kun kliniske interventionsstudier, hvor forskere i behandlingen af deltagere med RMP med enten konventionel mekanisk rengøring alene eller suppleret med systemisk antibiotika var berettiget til udvælgelse. To forfattere vurderede uafhængigt af hinanden risikoen for bias i hver af de udvalgte undersøgelser.
Resultater
– Der identificeredes 13 artikler, og forfatterne inkluderede seks af dem. Forskere rapporterede i alle undersøgelser om større reduktioner i pochedybde eller tab af klinisk fæste efter supplerende systemisk antibiotisk behandling sammenlignet med konventionel mekanisk rengøring alene. De antibiotika, der blev undersøgt, omfattede: metronidazol, clindamycin, tetracyklin hydrochlorid, amoxicillin, og amoxicillin med clavulansyre. Fem undersøgelser blev præsenteret med en høj risiko for bias, og ét studie blev præsenteret med en uklar risiko.
Konklusioner og praktiske implikationer
– Kvaliteten af den samlede dokumentation tillader ikke den konklusion, at supplerende systemisk antibiotika i behandlingen af refraktær marginal parodontitis forøger effekten sammenlignet med konventionel mekanisk behandling alene.
CLINICAL RELEVANCE
Although the investigators in the studies we evaluated in this review reported greater success in treating RP with adjunct antibiotic therapy, the overall body of evidence still does not support its use unequivocally.
Background – The goal in treating refractory periodontitis (RP) is to arrest or slow disease progression, which usually has included the use of systemic antibiotics adjunct to conventional mechanical debridement. The aim of this systematic review was to evaluate the evidence that the association of systemic antibiotics with conventional mechanical debridement increases the efficacy of periodontal therapy in the treatment of RP.
Types of studies reviewed – The authors searched for studies in PubMed MEDLINE, Cochrane Central Register of Controlled Trials, Thomson Reuters Web of Science, Scopus, Latin American and Caribbean Center on Health Sciences Information, and Scientific Electronic Library Online electronic databases by using selected key words from the earliest records up through October 31, 2014. Only clinical intervention studies in which investigators compared the treatment of participants with RP with either mechanical debridement alone or associated with systemic antibiotics were eligible for selection. Two authors independently assessed the risk of bias of each selected study.
Results – The authors identified 13 articles and included 6 of them. Investigators in all studies reported greater reductions in probing depth or in loss of clinical attachment level after adjunct systemic antibiotic therapy when compared with mechanical debridement alone. Antibiotics tested included metronidazole, clindamycin, tetracycline hydrochloride, amoxicillin, and amoxicillin and potassium clavulanate. Five studies presented a high risk of bias, and one study presented an unclear risk.
Conclusions and practical implications – The overall quality of the evidence does not allow the conclusion that adjunct systemic antibiotics are of additional benefit to conventional mechanical debridement alone.
