Comparison of 2 adjunctive antibiotic regimes in initial periodontal therapy

Antimicrobials have been shown to have beneficial effects when used as adjuncts to root surface debridement (RSD) compared to RSD alone, in the treatment of aggressive periodontal disease (AgP). Both a combination of amoxycillin (Amx) & metrondiazole (Mtz)(Griffiths et al. 2011) and azithromycin (Azithro) (Haas et al. 2008) have been shown to be efficacious. However, variations in the study designs prevents direct comparison of the 2 regimens. Objectives: to provide some pilot data on pocket depth reduction, which would allow a more direct comparison to be made between the 2 antimicrobial regimens. Methods: A retrospective analysis was carried out for 10 patients with AgP who were treated with RSD plus the combination of Amx & Mtz and a further 10 patients who were treated with RSD plus Azithro. Patients were treated in the unit of restorative Dentistry by postgraduates and hospital trainees. Patients were identified from log book records of the individuals in training. Patients could only be included if they had a baseline record of pocket depths and a 3 month re-assessment of this data. Patients were also required to be undergoing their first cycle of periodontal treatment (untreated cases).

Results: Average pocket depth reduction for moderate pockets (4-6mm) was 1.8mm in the Amx & Mtz group whereas it was 2.1mm in the Azithro group. In deep pockets (≥ 7mm) mean pocket depth reduction was 3.4mm for Amx & Mtz compared to 4.1 for Azith. The % sites improving by ≥2mm was 68% in Amx & Mtz compared to 79% for Azithro.

Conclusions: From this pilot data we can conclude that the outcomes are similar, with azithromycin giving slightly better pocket depth reduction. No formal statistical analysis was undertaken as the subject numbers are too small, but the pilot data helps planning for further investigation.