Cochrane · intervention · CD012568
Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis
Khattri, S, Kumbargere Nagraj, S, Arora, A, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
174
current version
GRADE rated
30
No studies
40
Included studies
45
as reported
No studies 40 · 23%Ungraded 104 · 59.8%Very low 30 · 17.2%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | All individuals with clinically diagnosed untreated periodontitis (chronic/aggressive). Exclusions: necrotizing periodontitis; recurrent periodontitis; refractory periodontitis; periodontitis as a manifestation of systemic disease; pregnancy; systemic disease/condition which can predispose to periodontitis (e.g. diabetes) | Adults (>= 18 years) with clinically diagnosed untreated chronic or aggressive periodontitis; 2664 participants across 45 trials conducted worldwide (30 parallel-arm, 14 multi-arm) |
| Intervention | Systemic use of antimicrobials as an adjunct to scaling and root planing (SRP). Interventions comparing different antimicrobials administered systemically (different drugs/dosage regimens/combinations/time periods) as an adjunct to SRP | Amoxicillin + metronidazole + SRP (n=18 studies); Metronidazole + SRP (n=8 studies); Azithromycin + SRP (n=9 studies); Amoxicillin + clavulanate + SRP (n=2 studies); Doxycycline + SRP (n=3 studies); Tetracycline + SRP (n=1 study); Clarithromycin + SRP (n=2 studies); Moxifloxacin + SRP (n=1 study); Levofloxacin + SRP (n=2 studies); Clindamycin + SRP (n=1 study); Cefixime + SRP (n=1 study); Minocycline + SRP (n=1 study); Spiramycin + SRP (n=1 study) |
| Comparison | SRP alone or SRP with placebo | SRP alone or placebo; other systemic antibiotics + SRP (head-to-head comparisons) |
| Outcomes | Primary: Percentage of closed pockets (pocket depth < 4 mm). Secondary: Clinical/relative attachment level (CAL); Probing pocket depth; Percentage of bleeding on probing (BOP); Antimicrobial resistance; Adverse effects of antibiotics; Long-term stability of CAL and pocket depth; Patient-reported quality of life changes | Percentage of closed pockets (n=4 studies); Clinical attachment level (n=38 studies); Probing pocket depth (n=38 studies); Percentage of bleeding on probing (n=40 studies); Adverse events (n=29 studies); Antimicrobial resistance (n=0 studies); Patient-reported quality of life changes (n=0 studies) |
| Study designs | Randomised controlled trials (RCTs). Exclusions: quasi-RCTs, cross-over, and split-mouth trials | Randomised controlled trials (n=45 studies; 38 contributed data to meta-analysis) |
| Timing | Short-term (<= 3 months); intermediate-term (> 3 months to < 1 year); long-term (>= 1 year) follow-up | Short-term (<= 3 months); intermediate-term (> 3 months to < 1 year); long-term (>= 1 year) |
Search date: 2020-03. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov; World Health Organization International Clinical Trials Registry Platform
Questions and results
Current version onlyAmoxicillin + metronidazole + SRP vs SRP
Population: Adults with periodontitis (chronic and aggressive)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Probing pocket depth Intermediate-term (> 3 months to < 1 year) | MD -0.47 [-0.68, -0.26] | 6 studies · 215 participants | Ungraded |
Probing pocket depth Short-term (≤ 3 months) | MD -0.18 [-0.33, -0.04] | 15 studies · 562 participants | Ungraded |
Percentage of closed pockets Intermediate-term (> 3 months to < 1 year) | MD -13.90 [-24.16, -3.64] | 1 study · 44 participants | Ungraded |
Percentage of bleeding on probing (BOP) Intermediate-term (> 3 months to < 1 year) | MD -5.32 [-12.02, 1.37] | 5 studies · 172 participants | Ungraded |
Clinical attachment level (CAL) Short-term (≤ 3 months) | MD -0.21 [-0.41, -0.01] | 13 studies · 501 participants | Ungraded |
Probing pocket depth Long-term (≥ 1 year) | MD -0.30 [-0.42, -0.18] | 2 studies · 389 participants | Very low Downgraded: risk of bias, imprecision |
Patient-reported quality of life changes Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Percentage of closed pockets Long-term (≥ 1 year) | MD -16.20 [-25.87, -6.53] | 1 study · 44 participants | Very low Downgraded: risk of bias, imprecision |
Antimicrobial resistance Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Percentage of bleeding on probing (BOP) Short-term (≤ 3 months) | MD -2.05 [-2.98, -1.11] | 13 studies · 460 participants | Ungraded |
Clinical attachment level (CAL) Long-term (≥ 1 year) | MD -0.47 [-0.90, -0.05] | 2 studies · 389 participants | Very low Downgraded: risk of bias, imprecision |
Clinical attachment level (CAL) Intermediate-term (> 3 months to < 1 year) | MD -0.04 [-0.35, 0.26] | 6 studies · 215 participants | Ungraded |
Adverse events 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 Downgraded: risk of bias, imprecision |
Percentage of bleeding on probing (BOP) Long-term (≥ 1 year) | MD -8.06 [-14.26, -1.85] | 2 studies · 389 participants | Very low Downgraded: risk of bias, imprecision |
Percentage of closed pockets Short-term (≤ 3 months) | MD -10.05 [-18.78, -1.32] | 2 studies · 73 participants | Ungraded |
Metronidazole + SRP vs SRP
Population: Adults with periodontitis (chronic and aggressive)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Percentage of closed pockets Intermediate-term (> 3 months to < 1 year) | MD -7.00 [-23.57, 9.57] | 1 study · 22 participants | Ungraded |
Percentage of bleeding on probing (BOP) Short-term (≤ 3 months) | MD -9.00 [-16.59, -1.40] | 4 studies · 108 participants | Ungraded |
Percentage of bleeding on probing (BOP) Long-term (≥ 1 year) | MD -6.90 [-22.10, 8.30] | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Probing pocket depth Long-term (≥ 1 year) | MD -1.11 [-2.84, 0.61] | 2 studies · 47 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events Long-term (≥ 1 year) | No severe adverse effects were reported by any of the participants in 1 study. 2 studies have not reported adverse events. | 3 studies · 71 participants | Very low Downgraded: risk of bias, imprecision |
Percentage of closed pockets Long-term (≥ 1 year) | MD -12.20 [-29.23, 4.83] | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision |
Probing pocket depth Intermediate-term (> 3 months to < 1 year) | MD -0.59 [-0.95, -0.23] | 4 studies · 94 participants | Ungraded |
Clinical attachment level (CAL) Short-term (≤ 3 months) | MD 0.04 [-0.43, 0.50] | 4 studies · 108 participants | Ungraded |
Antimicrobial resistance Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Clinical attachment level (CAL) Long-term (≥ 1 year) | MD -1.12 [-2.24, 0.00] | 3 studies · 71 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Patient-reported quality of life changes Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Probing pocket depth Short-term (≤ 3 months) | MD -0.10 [-0.37, 0.16] | 4 studies · 108 participants | Ungraded |
Percentage of bleeding on probing (BOP) Intermediate-term (> 3 months to < 1 year) | MD -4.62 [-18.83, 9.58] | 2 studies · 45 participants | Ungraded |
Percentage of closed pockets Short-term (≤ 3 months) | MD -2.56 [-12.33, 7.22] | 2 studies · 51 participants | Ungraded |
Clinical attachment level (CAL) Intermediate-term (> 3 months to < 1 year) | MD -0.49 [-1.29, 0.31] | 4 studies · 94 participants | Ungraded |
Azithromycin + SRP vs SRP
Population: Adults with periodontitis (chronic and aggressive)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Percentage of bleeding on probing (BOP) Intermediate-term (> 3 months to < 1 year) | MD -3.32 [-6.23, -0.42] | 6 studies · 228 participants | Ungraded |
Percentage of closed pockets Long-term (≥ 1 year) | MD 2.50 [-10.19, 15.19] | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Clinical attachment level (CAL) Long-term (≥ 1 year) | MD -0.59 [-1.27, 0.08] | 2 studies · 110 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Probing pocket depth Short-term (≤ 3 months) | MD -0.57 [-1.08, -0.07] | 6 studies · 216 participants | Ungraded |
Percentage of bleeding on probing (BOP) Long-term (≥ 1 year) | MD -1.28 [-4.32, 1.76] | 2 studies · 110 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Probing pocket depth Intermediate-term (> 3 months to < 1 year) | MD -0.60 [-1.02, -0.18] | 7 studies · 258 participants | Ungraded |
Clinical attachment level (CAL) Intermediate-term (> 3 months to < 1 year) | MD -0.43 [-0.77, -0.10] | 7 studies · 258 participants | Ungraded |
Probing pocket depth Long-term (≥ 1 year) | MD -0.77 [-2.33, 0.79] | 2 studies · 110 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Percentage of closed pockets Intermediate-term (> 3 months to < 1 year) | MD -2.90 [-13.91, 8.11] | 1 study · 40 participants | Ungraded |
Antimicrobial resistance Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Patient-reported quality of life changes Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Adverse events Long-term (≥ 1 year) | 1 study reported diarrhoea, headache or dizziness, metallic taste, and general unwellness by 4 participants from the intervention group and 3 from the control group. In 1 study none of the participants reported any… | 2 studies · 110 participants | Very low Downgraded: risk of bias, imprecision |
Percentage of bleeding on probing (BOP) Short-term (≤ 3 months) | MD -3.18 [-7.01, 0.65] | 6 studies · 216 participants | Ungraded |
Clinical attachment level (CAL) Short-term (≤ 3 months) | MD -0.51 [-0.83, -0.19] | 6 studies · 216 participants | Ungraded |
Amoxicillin + clavulanate + SRP vs SRP
Population: Adults with chronic periodontitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Percentage of closed pockets Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Patient-reported quality of life changes Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Probing pocket depth Long-term (≥ 1 year) | MD 0.10 [-0.17, 0.37] | 1 study · 21 participants | Very low Downgraded: risk of bias, imprecision |
Antimicrobial resistance Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Percentage of bleeding on probing (BOP) Long-term (≥ 1 year) | MD 0.00 [-0.09, 0.09] | 1 study · 21 participants | Very low Downgraded: risk of bias, imprecision |
Probing pocket depth Intermediate-term (> 3 months to < 1 year) | MD 0.00 [-0.19, 0.19] | 1 study · 21 participants | Ungraded |
Clinical attachment level (CAL) Intermediate-term (> 3 months to < 1 year) | MD 0.10 [-0.45, 0.65] | 1 study · 21 participants | Ungraded |
Adverse events Long-term (≥ 1 year) | Included study reported diarrhoea in 2 participants from both groups. | 1 study · 21 participants | Very low Downgraded: risk of bias, imprecision |
Clinical attachment level (CAL) Long-term (≥ 1 year) | MD 0.10 [-0.51, 0.71] | 1 study · 21 participants | Very low Downgraded: risk of bias, imprecision |
Probing pocket depth Short-term (≤ 3 months) | MD 0.20 [-0.02, 0.42] | 1 study · 21 participants | Ungraded |
Percentage of bleeding on probing (BOP) Short-term (≤ 3 months) | MD -0.10 [-0.19, -0.01] | 1 study · 21 participants | Ungraded |
Clinical attachment level (CAL) Short-term (≤ 3 months) | MD 0.10 [-0.43, 0.63] | 1 study · 21 participants | Ungraded |
Percentage of bleeding on probing (BOP) Intermediate-term (> 3 months to < 1 year) | MD -0.10 [-0.19, -0.01] | 1 study · 21 participants | Ungraded |
Doxycycline + SRP vs SRP
Population: Adults with aggressive periodontitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Probing pocket depth Long-term (≥ 1 year) | MD -1.00 [-1.78, -0.22] | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision |
Clinical attachment level (CAL) Long-term (≥ 1 year) | MD -0.80 [-1.49, -0.11] | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision |
Percentage of bleeding on probing (BOP) Intermediate-term (> 3 months to < 1 year) | MD -0.01 [-0.21, 0.19] | 1 study · 21 participants | Ungraded |
Percentage of bleeding on probing (BOP) Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Patient-reported quality of life changes Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Probing pocket depth Short-term (≤ 3 months) | MD 0.10 [-0.29, 0.50] | 2 studies · 43 participants | Ungraded |
Clinical attachment level (CAL) Intermediate-term (> 3 months to < 1 year) | MD -0.61 [-1.14, -0.08] | 3 studies · 65 participants | Ungraded |
Clinical attachment level (CAL) Short-term (≤ 3 months) | MD 0.15 [-0.53, 0.83] | 2 studies · 43 participants | Ungraded |
Antimicrobial resistance Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Probing pocket depth Intermediate-term (> 3 months to < 1 year) | MD -0.43 [-0.88, 0.01] | 3 studies · 65 participants | Ungraded |
Adverse events Long-term (≥ 1 year) | Included study has not reported adverse events | NR | No studies |
Percentage of closed pockets Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Percentage of bleeding on probing (BOP) Short-term (≤ 3 months) | MD -0.09 [-0.29, 0.11] | 1 study · 21 participants | Ungraded |
Tetracycline + SRP vs SRP
Population: Adults with aggressive periodontitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical attachment level (CAL) Intermediate-term (> 3 months to < 1 year) | MD -1.90 [-2.17, -1.63] | 1 study · 26 participants | Ungraded |
Clinical attachment level (CAL) Short-term (≤ 3 months) | MD -0.92 [-2.38, 0.54] | 2 studies · 64 participants | Ungraded |
Adverse events Long-term (≥ 1 year) | Included study has not reported adverse events | NR | No studies |
Percentage of closed pockets Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Patient-reported quality of life changes Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Probing pocket depth Short-term (≤ 3 months) | MD -0.53 [-1.14, 0.08] | 1 study · 38 participants | Ungraded |
Probing pocket depth Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Clinical attachment level (CAL) Long-term (≥ 1 year) | MD -2.30 [-2.50, -2.10] | 1 study · 26 participants | Very low Downgraded: risk of bias, imprecision |
Percentage of bleeding on probing (BOP) Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Percentage of bleeding on probing (BOP) Short-term (≤ 3 months) | MD -14.62 [-27.21, -2.03] | 1 study · 38 participants | Ungraded |
Antimicrobial resistance Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Clarithromycin + SRP vs SRP
Population: Adults with periodontitis (chronic and aggressive)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Percentage of bleeding on probing (BOP) Intermediate-term (> 3 months to < 1 year) | MD -4.70 [-8.42, -0.98] | 1 study · 40 participants | Ungraded |
Adverse events | Both included trials reported adverse events in the clarithromycin + SRP group: unpalatable taste and mild gastric intolerance in 2 patients (Pradeep 2011); mild gastrointestinal discomfort in 2 patients (Rebelatto… | NR | Ungraded |
Clinical attachment level (CAL) Short-term (≤ 3 months) | MD -0.65 [-1.20, -0.09] | 2 studies · 77 participants | Ungraded |
Probing pocket depth Short-term (≤ 3 months) | MD -0.59 [-1.17, -0.01] | 2 studies · 77 participants | Ungraded |
Clinical attachment level (CAL) Intermediate-term (> 3 months to < 1 year) | MD -0.64 [-1.26, -0.03] | 2 studies · 77 participants | Ungraded |
Percentage of bleeding on probing (BOP) Short-term (≤ 3 months) | MD -3.00 [-6.69, 0.69] | 1 study · 40 participants | Ungraded |
Probing pocket depth Intermediate-term (> 3 months to < 1 year) | MD -0.67 [-1.33, -0.01] | 2 studies · 77 participants | Ungraded |
Moxifloxacin + SRP vs SRP
Population: Adults with chronic periodontitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events | The included trial (Ardila 2015) had no adverse events amongst the participants. | 1 study · 40 participants | Ungraded |
Clinical attachment level (CAL) Intermediate-term (> 3 months to < 1 year) | MD -0.63 [-0.95, -0.31] | 1 study · 40 participants | Ungraded |
Probing pocket depth Intermediate-term (> 3 months to < 1 year) | MD -0.42 [-0.74, -0.10] | 1 study · 40 participants | Ungraded |
Clinical attachment level (CAL) Short-term (≤ 3 months) | MD -0.67 [-1.01, -0.33] | 1 study · 40 participants | Ungraded |
Percentage of bleeding on probing (BOP) Short-term (≤ 3 months) | MD -3.40 [-3.72, -3.08] | 1 study · 40 participants | Ungraded |
Percentage of bleeding on probing (BOP) Intermediate-term (> 3 months to < 1 year) | MD -0.80 [-1.12, -0.48] | 1 study · 40 participants | Ungraded |
Probing pocket depth Short-term (≤ 3 months) | MD -0.55 [-0.87, -0.23] | 1 study · 40 participants | Ungraded |
Levofloxacin + SRP vs SRP
Population: Adults with chronic periodontitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Percentage of bleeding on probing (BOP) Short-term (≤ 3 months) | MD -1.38 [-3.30, 0.54] | 2 studies · 131 participants | Ungraded |
Probing pocket depth Intermediate-term (> 3 months to < 1 year) | MD -1.23 [-1.46, -1.00] | 2 studies · 131 participants | Ungraded |
Adverse events | Both included trials (Pradeep 2014; Pradeep 2015) reported dizziness and diarrhoea in the levofloxacin + SRP group. | 2 studies | Ungraded |
Probing pocket depth Short-term (≤ 3 months) | MD -1.09 [-1.33, -0.85] | 2 studies · 131 participants | Ungraded |
Clinical attachment level (CAL) Short-term (≤ 3 months) | MD -1.02 [-1.39, -0.65] | 2 studies · 131 participants | Ungraded |
Percentage of bleeding on probing (BOP) Intermediate-term (> 3 months to < 1 year) | MD -0.93 [-2.88, 1.02] | 2 studies · 131 participants | Ungraded |
Clinical attachment level (CAL) Intermediate-term (> 3 months to < 1 year) | MD -1.25 [-1.51, -0.99] | 2 studies · 131 participants | Ungraded |
Clindamycin + SRP vs SRP
Population: Adults with aggressive periodontitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical attachment level (CAL) Intermediate-term (> 3 months to < 1 year) | MD -1.30 [-2.14, -0.46] | 1 study · 21 participants | Ungraded |
Probing pocket depth Long-term (≥ 1 year) | MD -1.80 [-2.47, -1.13] | 1 study · 21 participants | Very low Downgraded: risk of bias, imprecision |
Probing pocket depth Intermediate-term (> 3 months to < 1 year) | MD -1.10 [-1.94, -0.26] | 1 study · 21 participants | Ungraded |
Antimicrobial resistance Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Percentage of bleeding on probing (BOP) Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Clinical attachment level (CAL) Long-term (≥ 1 year) | MD -1.70 [-2.40, -1.00] | 1 study · 21 participants | Very low Downgraded: risk of bias, imprecision |
Percentage of closed pockets Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Adverse events Long-term (≥ 1 year) | Included study has not reported adverse events | NR | No studies |
Clinical attachment level (CAL) Short-term (≤ 3 months) | MD 0.40 [-0.35, 1.15] | 1 study · 21 participants | Ungraded |
Probing pocket depth Short-term (≤ 3 months) | MD 0.10 [-0.55, 0.75] | 1 study · 21 participants | Ungraded |
Patient-reported quality of life changes Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Cefixime + SRP vs SRP
Population: Adults with chronic periodontitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events | The only included trial (Dukic 2016) reported nausea, dizziness and/or anorexia in the cefixime + SRP group. | 1 study · 60 participants | Ungraded |
Percentage of bleeding on probing (BOP) Short-term (≤ 3 months) | MD -0.48 [-0.60, -0.37] | 1 study · 60 participants | Ungraded |
Clinical attachment level (CAL) Short-term (≤ 3 months) | MD -0.19 [-0.77, 0.39] | 1 study · 60 participants | Ungraded |
Probing pocket depth Short-term (≤ 3 months) | MD -0.02 [-0.11, 0.07] | 1 study · 60 participants | Ungraded |
Metronidazole + SRP vs Amoxicillin + metronidazole + SRP
Population: Adults with periodontitis (chronic and aggressive)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical attachment level (CAL) Intermediate-term (> 3 months to < 1 year) | MD 0.06 [-1.06, 1.18] | 1 study · 22 participants | Ungraded |
Adverse events | All three included trials (Matarazzo 2008; Silva 2011; Xajigeorgiou 2006) reported adverse events in both MTZ + SRP and AMOX + MTZ + SRP groups (nausea, vomiting, diarrhoea, headache, metallic taste, irritability, mild… | 3 studies · 84 participants | Ungraded |
Clinical attachment level (CAL) Short-term (≤ 3 months) | MD -0.07 [-0.40, 0.26] | 3 studies · 84 participants | Ungraded |
Probing pocket depth Intermediate-term (> 3 months to < 1 year) | MD -0.26 [-0.83, 0.31] | 1 study · 22 participants | Ungraded |
Percentage of bleeding on probing (BOP) Short-term (≤ 3 months) | MD 4.46 [-23.48, 32.40] | 3 studies · 84 participants | Ungraded |
Percentage of bleeding on probing (BOP) Intermediate-term (> 3 months to < 1 year) | MD 20.85 [3.31, 38.39] | 1 study · 22 participants | Ungraded |
Probing pocket depth Short-term (≤ 3 months) | MD 0.10 [-0.12, 0.32] | 3 studies · 84 participants | Ungraded |
Doxycycline + SRP vs Amoxicillin + metronidazole + SRP
Population: Adults with aggressive periodontitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Probing pocket depth Short-term (≤ 3 months) | MD 0.14 [-0.12, 0.40] | 2 studies · 50 participants | Ungraded |
Clinical attachment level (CAL) Intermediate-term (> 3 months to < 1 year) | MD 0.17 [-1.28, 1.62] | 1 study · 20 participants | Ungraded |
Clinical attachment level (CAL) Short-term (≤ 3 months) | MD 0.20 [0.06, 0.33] | 2 studies · 50 participants | Ungraded |
Adverse events | One trial (Akincibay 2008) did not report this outcome; Xajigeorgiou 2006 reported mild gastrointestinal discomfort in 2 subjects from the AMOX + MTZ + SRP group. | 1 study | Ungraded |
Probing pocket depth Intermediate-term (> 3 months to < 1 year) | MD 0.23 [-0.41, 0.87] | 1 study · 20 participants | Ungraded |
Doxycycline + SRP vs Metronidazole + SRP
Population: Adults with aggressive periodontitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Probing pocket depth Intermediate-term (> 3 months to < 1 year) | MD 0.38 [0.00, 0.76] | 3 studies · 75 participants | Ungraded |
Clinical attachment level (CAL) Intermediate-term (> 3 months to < 1 year) | MD 0.34 [-0.08, 0.76] | 3 studies · 75 participants | Ungraded |
Clinical attachment level (CAL) Short-term (≤ 3 months) | MD -0.12 [-0.72, 0.49] | 2 studies · 49 participants | Ungraded |
Percentage of bleeding on probing (BOP) Short-term (≤ 3 months) | MD -0.05 [-0.22, 0.12] | 1 study · 22 participants | Ungraded |
Percentage of bleeding on probing (BOP) Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Patient-reported quality of life changes Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Adverse events Long-term (≥ 1 year) | Included studies have not reported adverse events | NR | No studies |
Clinical attachment level (CAL) Long-term (≥ 1 year) | MD 1.10 [0.36, 1.84] | 1 study · 27 participants | Very low Downgraded: risk of bias, imprecision |
Antimicrobial resistance Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Percentage of bleeding on probing (BOP) Intermediate-term (> 3 months to < 1 year) | MD -0.07 [-0.29, 0.15] | 1 study · 22 participants | Ungraded |
Percentage of closed pockets Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Probing pocket depth Long-term (≥ 1 year) | MD 1.00 [0.30, 1.70] | 1 study · 27 participants | Very low Downgraded: risk of bias, imprecision |
Probing pocket depth Short-term (≤ 3 months) | MD -0.16 [-0.56, 0.24] | 2 studies · 49 participants | Ungraded |
Clindamycin + SRP vs Metronidazole + SRP
Population: Adults with aggressive periodontitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Probing pocket depth Short-term (≤ 3 months) | MD -0.14 [-0.82, 0.54] | 1 study · 26 participants | Ungraded |
Patient-reported quality of life changes Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Probing pocket depth Intermediate-term (> 3 months to < 1 year) | MD -0.10 [-0.79, 0.59] | 1 study · 26 participants | Ungraded |
Percentage of closed pockets Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Clinical attachment level (CAL) Short-term (≤ 3 months) | MD 0.40 [-0.22, 1.02] | 1 study · 26 participants | Ungraded |
Antimicrobial resistance Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Adverse events Long-term (≥ 1 year) | Included study has not reported adverse events | NR | No studies |
Clinical attachment level (CAL) Long-term (≥ 1 year) | MD 0.20 [-0.55, 0.95] | 1 study · 26 participants | Very low Downgraded: risk of bias, imprecision |
Clinical attachment level (CAL) Intermediate-term (> 3 months to < 1 year) | MD 0.10 [-0.60, 0.80] | 1 study · 26 participants | Ungraded |
Probing pocket depth Long-term (≥ 1 year) | MD 0.20 [-0.38, 0.78] | 1 study · 26 participants | Very low Downgraded: risk of bias, imprecision |
Percentage of bleeding on probing (BOP) Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Amoxicillin + clavulanate + SRP vs Tetracycline + SRP
Population: Adults with aggressive periodontitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events | The only included trial (Abu Fanas 1991) reported there were no adverse events. | 1 study · 8 participants | Ungraded |
Percentage of bleeding on probing (BOP) Intermediate-term (> 3 months to < 1 year) | MD -1.60 [-14.03, 10.83] | 1 study · 8 participants | Ungraded |
Probing pocket depth Intermediate-term (> 3 months to < 1 year) | MD -0.40 [-1.11, 0.31] | 1 study · 8 participants | Ungraded |
Clindamycin + SRP vs Doxycycline + SRP
Population: Adults with aggressive periodontitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Antimicrobial resistance Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Probing pocket depth Short-term (≤ 3 months) | MD 0.20 [-0.36, 0.76] | 1 study · 23 participants | Ungraded |
Clinical attachment level (CAL) Long-term (≥ 1 year) | MD -0.90 [-1.62, -0.18] | 1 study · 23 participants | Very low Downgraded: risk of bias, imprecision |
Clinical attachment level (CAL) Intermediate-term (> 3 months to < 1 year) | MD -0.40 [-1.15, 0.35] | 1 study · 23 participants | Ungraded |
Probing pocket depth Long-term (≥ 1 year) | MD -0.80 [-1.58, -0.02] | 1 study · 23 participants | Very low Downgraded: risk of bias, imprecision |
Patient-reported quality of life changes Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Adverse events Long-term (≥ 1 year) | Included study has not reported adverse events | NR | No studies |
Percentage of bleeding on probing (BOP) Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Probing pocket depth Intermediate-term (> 3 months to < 1 year) | MD -0.40 [-1.14, 0.34] | 1 study · 23 participants | Ungraded |
Clinical attachment level (CAL) Short-term (≤ 3 months) | MD 0.50 [-0.26, 1.26] | 1 study · 23 participants | Ungraded |
Percentage of closed pockets Long-term (≥ 1 year) | Included studies have not reported this outcome | NR | No studies |
Amoxicillin + metronidazole + SRP vs Clarithromycin + SRP
Population: Adults with aggressive periodontitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events | Two patients were reported to have vomiting and unbearable stomach pain in the AMOX + MTZ + SRP group (Araujo 2019). | 1 study | Ungraded |
Probing pocket depth Intermediate-term (> 3 months to < 1 year) | MD -0.10 [-0.26, 0.06] | 1 study · 46 participants | Ungraded |
Percentage of bleeding on probing (BOP) Intermediate-term (> 3 months to < 1 year) | MD 4.00 [-1.09, 9.09] | 1 study · 46 participants | Ungraded |
Clinical attachment level (CAL) Intermediate-term (> 3 months to < 1 year) | MD 0.00 [-0.26, 0.26] | 1 study · 46 participants | Ungraded |
Probing pocket depth Short-term (≤ 3 months) | MD -0.20 [-0.35, -0.05] | 1 study · 46 participants | Ungraded |
Clinical attachment level (CAL) Short-term (≤ 3 months) | MD -0.60 [-0.86, -0.34] | 1 study · 46 participants | Ungraded |
Percentage of bleeding on probing (BOP) Short-term (≤ 3 months) | MD 5.40 [-0.12, 10.92] | 1 study · 46 participants | Ungraded |
Systemic antimicrobials as an adjunct to SRP vs SRP alone or SRP with placebo
Population: Individuals with clinically diagnosed untreated periodontitis (chronic/aggressive); excluding necrotizing/recurrent/refractory periodontitis, periodontitis as a manifestation of systemic disease, pregnancy, and systemic disease (e.g. HIV, diabetes)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Probing pocket depth (PPD) | no estimate extracted | NR | No studies |
Adverse effects of antibiotics | no estimate extracted | NR | No studies |
Percentage of closed pockets (pocket depth < 4 mm) | no estimate extracted | NR | No studies |
Patient-reported quality of life changes | no estimate extracted | NR | No studies |
Antimicrobial resistance | no estimate extracted | NR | No studies |
Bleeding on probing (BOP) | no estimate extracted | NR | No studies |
Clinical/relative attachment level (CAL/RAL) | no estimate extracted | NR | No studies |
One systemic antimicrobial as an adjunct to SRP vs Another systemic antimicrobial as an adjunct to SRP
Population: Individuals with clinically diagnosed untreated periodontitis (chronic/aggressive); excluding necrotizing/recurrent/refractory periodontitis, periodontitis as a manifestation of systemic disease, pregnancy, and systemic disease (e.g. HIV, diabetes)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Probing pocket depth (PPD) | no estimate extracted | NR | No studies |
Patient-reported quality of life changes | no estimate extracted | NR | No studies |
Adverse effects of antibiotics | no estimate extracted | NR | No studies |
Percentage of closed pockets (pocket depth < 4 mm) | no estimate extracted | NR | No studies |
Bleeding on probing (BOP) | no estimate extracted | NR | No studies |
Clinical/relative attachment level (CAL/RAL) | no estimate extracted | NR | No studies |
Antimicrobial resistance | no estimate extracted | NR | No studies |