What do systematic reviews say?

Topical metronidazole vs oral (oxy)tetracycline

• Interventions for rosacea 2015 · Cochrane Headline outcomes only
  no estimate extracted
  4 studies · 258 participants
  Moderate

Topical metronidazole vs oral (oxy)tetracycline

• Interventions for rosacea 2015 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 81 participants
  Moderate

Topical metronidazole vs oral (oxy)tetracycline

• Interventions for rosacea 2015 · Cochrane Headline outcomes only
  no estimate extracted
  4 studies · 258 participants
  Low

Topical metronidazole vs oral (oxy)tetracycline

• Interventions for rosacea 2015 · Cochrane Headline outcomes only
  no estimate extracted
  4 studies · 258 participants
  Moderate

Topical metronidazole vs oral (oxy)tetracycline

The review found no eligible studies for this question.

• Interventions for rosacea 2015 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found

Topical metronidazole vs oral (oxy)tetracycline

The review found no eligible studies for this question.

• Interventions for rosacea 2015 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found

Metronidazole (intrasocket) vs placebo

Metronidazole (intrasocket) led to lower duration of treatment (days) compared with placebo; GRADE not reported.

• Local interventions for the management of alveolar osteitis (dry socket) 2022 · Cochrane All outcomes
  MD -3.17 [-5.30, -1.04]
  1 study · 55 participants
  GRADE not reported

Amoxicillin + metronidazole + SRP vs SRP

Amoxicillin + metronidazole + SRP led to lower probing pocket depth compared with SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -0.47 [-0.68, -0.26]
  6 studies · 215 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -0.18 [-0.33, -0.04]
  15 studies · 562 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  MD -0.30 [-0.42, -0.18]
  2 studies · 389 participants
  Very low

Amoxicillin + metronidazole + SRP vs Clarithromycin + SRP

Amoxicillin + metronidazole + SRP showed no clear difference in clinical attachment level (CAL) compared with clarithromycin + SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD 0.00 [-0.26, 0.26]
  1 study · 46 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -0.60 [-0.86, -0.34]
  1 study · 46 participants
  GRADE not reported

Amoxicillin + metronidazole + SRP vs SRP

Amoxicillin + metronidazole + SRP led to lower percentage of bleeding on probing (BOP) compared with SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -2.05 [-2.98, -1.11]
  13 studies · 460 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -5.32 [-12.02, 1.37]
  5 studies · 172 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  MD -8.06 [-14.26, -1.85]
  2 studies · 389 participants
  Very low

Amoxicillin + metronidazole + SRP vs Clarithromycin + SRP

Amoxicillin + metronidazole + SRP led to lower probing pocket depth compared with clarithromycin + SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -0.20 [-0.35, -0.05]
  1 study · 46 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -0.10 [-0.26, 0.06]
  1 study · 46 participants
  GRADE not reported

Amoxicillin + metronidazole + SRP vs SRP

It is very uncertain whether amoxicillin + metronidazole + SRP changes clinical attachment level (CAL) compared with SRP (very low certainty).

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  MD -0.47 [-0.90, -0.05]
  2 studies · 389 participants
  Very low
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -0.21 [-0.41, -0.01]
  13 studies · 501 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -0.04 [-0.35, 0.26]
  6 studies · 215 participants
  GRADE not reported

Amoxicillin + metronidazole + SRP vs Clarithromycin + SRP

Amoxicillin + metronidazole + SRP showed no clear difference in adverse events compared with clarithromycin + SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes
  Two patients were reported to have vomiting and unbearable stomach pain in the AMOX + MTZ + SRP group (Araujo 2019).
  1 study
  GRADE not reported

Amoxicillin + metronidazole + SRP vs SRP

Amoxicillin + metronidazole + SRP led to lower percentage of closed pockets compared with SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -13.90 [-24.16, -3.64]
  1 study · 44 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  MD -16.20 [-25.87, -6.53]
  1 study · 44 participants
  Very low
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -10.05 [-18.78, -1.32]
  2 studies · 73 participants
  GRADE not reported

Amoxicillin + metronidazole + SRP vs SRP

The review found no eligible studies for this question.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  Included studies have not reported this outcome
  Studies not reported
  No studies found

Amoxicillin + metronidazole + SRP vs Clarithromycin + SRP

Amoxicillin + metronidazole + SRP showed no clear difference in percentage of bleeding on probing (BOP) compared with clarithromycin + SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD 4.00 [-1.09, 9.09]
  1 study · 46 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD 5.40 [-0.12, 10.92]
  1 study · 46 participants
  GRADE not reported

Amoxicillin + metronidazole + SRP vs SRP

The review found no eligible studies for this question.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  Included studies have not reported this outcome
  Studies not reported
  No studies found

Amoxicillin + metronidazole + SRP vs SRP

It is very uncertain whether amoxicillin + metronidazole + SRP changes adverse events compared with SRP (very low certainty).

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  Most common adverse events were mild gastrointestinal disturbances, nausea and vomiting, metallic taste, and diarrhoea in the intervention group. Control group reported adverse events like hypothermia, mild…
  2 studies · 389 participants
  Very low

Metronidazole gel 25% (local antibiotic) vs Placebo gel

Metronidazole gel (25%, intrasocket) showed no clear difference in presence of dry socket compared with placebo gel; GRADE not reported.

• Local interventions for the management of alveolar osteitis (dry socket) 2022 · Cochrane All outcomes

  Follow-up: median 7 days
  RR 0.53 [0.23, 1.20]
  1 study · 302 participants
  GRADE not reported

Metronidazole gel 25% (local antibiotic) vs Ultrasonic debridement

Metronidazole gel 25% (local antibiotic) showed no clear difference in change in probing pocket depth compared with ultrasonic debridement; GRADE not reported.

• Interventions for replacing missing teeth: treatment of peri‐implantitis 2012 · Cochrane All outcomes

  12 weeks
  After 12 weeks there was no statistically significant difference in PPD changes.
  1 study · 27 participants
  GRADE not reported