Azithromycin as an adjunct to subgingival professional mechanical plaque removal in the treatment of grade C periodontitis: a systematic review and meta-analysis
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The aim of this systematic review was to evaluate clinical and microbiological outcomes with the use of azithromycin as an adjunct to non-surgical subgingival professional mechanical plaque removal (PMPR) in the treatment of grade C periodontitis. Online database searches using high-level MeSH terms in a PICO structure were conducted along with hand-searching of relevant periodontal journals. Titles and abstracts of identified studies were independently reviewed by both authors and the full texts of studies meeting the inclusion criteria were independently reviewed. In total, 122 studies were identified through searches, of which 6 were included in the qualitative analysis and 4 in the meta-analysis. Three studies included in the meta-analysis were deemed at low risk of bias and 1 at serious risk. There were conflicting results on whether azithromycin reduced the number of subgingival pathogens or detectable subgingival Aggregatibacter actinomycetemcomitans between the included studies. The meta-analysis revealed a statistically significant probing depth reduction difference in favour of azithromycin compared to the control at 3 months (weighted mean difference [WMD]=−0.39 mm; 95% confidence interval [CI], −0.66 to −0.13 mm; I2 =0%) and 12 months (WMD=−1.32 mm; 95% CI, −1.71 to −0.93 mm; I2 =0%). The clinical attachment level change was also statistically significant in favour of azithromycin compared to the control at 3 months (WMD=−0.61 mm; 95% CI, −1.13 to −0.10 mm; I2 =71%) and 12 months (WMD=−0.88 mm; 95% CI, −1.32 to −0.44 mm; I2 =0%). Based upon these results, azithromycin offers additional improvements in some clinical parameters when used in conjunction with subgingival PMPR in patients with aggressive periodontitis over control groups. These improvements appear to be maintained for up to 12 months after treatment completion. However, due to a lack of well-designed studies, the conclusions that can be drawn from the available evidence are limited. Trial Registration: International Prospective Register of Systematic Reviews Identifier: CRD42020168195
Abstract
The aim of this systematic review was to evaluate clinical and microbiological outcomes with the use of azithromycin as an adjunct to non-surgical subgingival professional mechanical plaque removal (PMPR) in the treatment of grade C periodontitis. Online database searches using high-level MeSH terms in a PICO structure were conducted along with hand-searching of relevant periodontal journals. Titles and abstracts of identified studies were independently reviewed by both authors and the full texts of studies meeting the inclusion criteria were independently reviewed. In total, 122 studies were identified through searches, of which 6 were included in the qualitative analysis and 4 in the meta-analysis. Three studies included in the meta-analysis were deemed at low risk of bias and 1 at serious risk. There were conflicting results on whether azithromycin reduced the number of subgingival pathogens or detectable subgingival Aggregatibacter actinomycetemcomitans between the included studies. The meta-analysis revealed a statistically significant probing depth reduction difference in favour of azithromycin compared to the control at 3 months (weighted mean difference [WMD]=−0.39 mm; 95% confidence interval [CI], −0.66 to −0.13 mm; I2 =0%) and 12 months (WMD=−1.32 mm; 95% CI, −1.71 to −0.93 mm; I2 =0%). The clinical attachment level change was also statistically significant in favour of azithromycin compared to the control at 3 months (WMD=−0.61 mm; 95% CI, −1.13 to −0.10 mm; I2 =71%) and 12 months (WMD=−0.88 mm; 95% CI, −1.32 to −0.44 mm; I2 =0%). Based upon these results, azithromycin offers additional improvements in some clinical parameters when used in conjunction with subgingival PMPR in patients with aggressive periodontitis over control groups. These improvements appear to be maintained for up to 12 months after treatment completion. However, due to a lack of well-designed studies, the conclusions that can be drawn from the available evidence are limited. Trial Registration: International Prospective Register of Systematic Reviews Identifier: CRD42020168195
참고문헌 (41)
- American Academy of Periodontology, "Proceedings of the world workshop in clinical periodontics" (1989), American Academy of Periodontology
- Armitage GC, "Development of a classification system for periodontal diseases and conditions", Ann Periodontol, 4, pp.1~6 (1999)
- Lang N, "Consensus report : aggressive periodontitis", Ann Periodontol, 4, pp.53~ (1999)
- Albandar JM, "Aggressive periodontitis : case definition and diagnostic criteria", Periodontol 2000, 65, pp.13~26 (2014)
- Caton JG, "A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification", J Periodontol, 89(Suppl 1), pp.S1~S8 (1999)
- Papapanou PN, "Periodontitis: consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions", J Periodontol, 89(Suppl 1), pp.S173~S182 (2018)
- Fine DH, "Classification and diagnosis of aggressive periodontitis", J Clin Periodontol, 45(Suppl 20), pp.S95~S111 (2018)
- Susin C, "Epidemiology and demographics of aggressive periodontitis", Periodontol 2000, 65, pp.27~45 (2014)
- Eke PI, "Update on prevalence of periodontitis in adults in the United States : NHANES 2009 to 2012", J Periodontol, 86, pp.611~622 (2015)
- Sanz M, "Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline", J Clin Periodontol, 47(Suppl 22), pp.4~60 (2020)
- Deas DE, "Response of chronic and aggressive periodontitis to treatment", Periodontol 2000, 53, pp.154~166 (2010)
- Herrera D, "A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients", J Clin Periodontol, 29(Suppl 3), pp.136~159 (2002)
- Rabelo CC, "Systemic antibiotics in the treatment of aggressive periodontitis. A systematic review and a Bayesian Network meta-analysis", J Clin Periodontol, 42, pp.647~657 (2015)
- Keestra JA, "Non-surgical periodontal therapy with systemic antibiotics in patients with untreated chronic periodontitis : a systematic review and meta-analysis", J Periodontal Res, 50, pp.294~314 (2015)
- Teughels W, "Adjunctive effect of systemic antimicrobials in periodontitis therapy : a systematic review and meta-analysis", J Clin Periodontol, 47(Suppl 22), pp.257~281 (2020)
- Slots J, "Suppression of the periodontopathic microflora in localized juvenile periodontitis by systemic tetracycline", J Clin Periodontol, 10, pp.465~486 (1983)
- Saxén L, "Metronidazole in the treatment of localized juvenile periodontitis", J Clin Periodontol, 20, pp.166~171 (1993)
- Guerrero A, "Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive periodontitis : a randomized placebo-controlled clinical trial", J Clin Periodontol, 32, pp.1096~1107 (2005)
- "The good practitioner’s guide to periodontology" (2016)[URL]
- "Antimicrobial prescribing in dentistry: good practice guidelines" (2020)[URL]
- Guerrero A, "Incomplete adherence to an adjunctive systemic antibiotic regimen decreases clinical outcomes in generalized aggressive periodontitis patients : a pilot retrospective study", J Clin Periodontol, 34, pp.897~902 (2007)
- Jourdan A, "Antibiotic hypersensitivity and adverse reactions : management and implications in clinical practice", Allergy Asthma Clin Immunol, 16, pp.6~ (2020)
- Foulds G, "The pharmacokinetics of azithromycin in human serum and tissues", J Antimicrob Chemother, 25(Suppl A), pp.73~82 (1990)
- Ianaro A, "Anti-inflammatory activity of macrolide antibiotics", J Pharmacol Exp Ther, 292, pp.156~163 (2000)
- Foulds G, "Selection of dose regimens of azithromycin", J Antimicrob Chemother, 31(Suppl E), pp.39~50 (1993)
- Blandizzi C, "Periodontal tissue disposition of azithromycin in patients affected by chronic inflammatory periodontal diseases", J Periodontol, 70, pp.960~966 (1999)
- Gomi K, "Drug concentration in inflamed periodontal tissues after systemically administered azithromycin", J Periodontol, 78, pp.918~923 (2007)
- Moher D, "Preferred reporting items for systematic reviews and meta-analyses : the PRISMA statement", PLoS Med, 6, pp.e1000097~ (2009)
- Sterne JA, "ROBINS-I : a tool for assessing risk of bias in non-randomised studies of interventions", BMJ, 355, pp.i4919~ (2016)
- Sterne JA, "RoB 2 : a revised tool for assessing risk of bias in randomised trials", BMJ, 366, pp.l4898~ (2019)
- "Assessing risk of bias due to missing results in a synthesis. Cochrane handbook for systematic reviews of interventions" (2019)[URL]
- "GRADEpro guideline development tool (software)" (2020)[URL]
- Nordic Cochrane Centre, "Review Manager, version 5.3", Cochrane, ~ (2014)
- Emingil G, "Effect of azithromycin, as an adjunct to nonsurgical periodontal treatment, on microbiological parameters and gingival crevicular fluid biomarkers in generalized aggressive periodontitis", J Periodontal Res, 47, pp.729~739 (2012)
- Ercan E, "Effects of azithromycin versus metronidazole-amoxicillin combination as an adjunct to nonsurgical periodontal therapy of generalized aggressive periodontitis", Niger J Clin Pract, 18, pp.506~510 (2015)
- Fujii T, "Effect of systemically administered azithromycin in early onset aggressive periodontitis", Periodontal Pract Today, 1, pp.321~325 (2004)
- Haas AN, "Azithromycin as an adjunctive treatment of aggressive periodontitis : 12-months randomized clinical trial", J Clin Periodontol, 35, pp.696~704 (2008)
- Haas AN, "Adjunctive azithromycin in the treatment of aggressive periodontitis : microbiological findings of a 12-month randomized clinical trial", J Dent, 40, pp.556~563 (2012)
- Martande SS, "Clinical and microbiological effects of systemic azithromycin in adjunct to nonsurgical periodontal therapy in treatment of Aggregatibacter actinomycetemcomitans associated periodontitis: a randomized placebo-controlled clinical trial", J Investig Clin Dent, 7, pp.72~80 (2016)
- "Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use" (2015)[URL]
- "Commissioning standard for restorative dentistry" (2019)[URL]