Comparing the periodontal tissue response to non‐surgical scaling and root planing alone, adjunctive azithromycin, or adjunctive amoxicillin plus metronidazole in generalized chronic moderate‐to‐severe periodontitis: a preliminary randomized controlled trial

BACKGROUND: The usefulness of administrating adjunctive systemic antibiotics to expedite healing of periodontal tissues is a topic of interest given the lack of clear guidelines. AIM: To compare clinical outcomes in patients given adjunctive azithromycin (AZ), adjunctive amoxicillin plus metronidazole (AMX + MTZ), or scaling and root planing (SRP) alone in the treatment of moderate-to-severe chronic periodontitis. METHODS: Thirty-eight patients were randomly assigned into: SRP alone; 500 mg AMX plus 400 mg MTZ three times per day for 7 days; or 500 mg AZ for 3 days. Antibiotics were administered after the first SRP session and clinical parameters for full-mouth and baseline probing pocket depth (PPD) categories were reviewed 2-months post-treatment. RESULTS: Thirty-four of 38 patients completed the study. All groups experienced significant improvements in full-mouth clinical attachment level (CAL), probing pocket depth (PPD) and bleeding on probing. AZ exhibited greater reductions in PPD than SRP alone for baseline severe sites, whilst AMX+MTZ showed significant improvements in PPD and CAL than SRP alone for baseline moderate and severe sites. Of the two antibiotic therapies, AMX+MTZ showed greater reductions in PPD compared with AZ in baseline moderate sites only. CONCLUSIONS: For patients with moderate-to-severe periodontitis, adjunctive systemic antibiotics might result in greater clinical benefits.