Abstract\nBackground: The treatment of periodontitis begins with a non-surgical phase that includes scaling and root\nplaning(SRP) and on occasion the use of systemic antibiotics. The goal was to systematically evaluate in systemic\nhealthy adults the effect of the concomitant administration of amoxicillin (amx) and metronidazole (met) adjunctive\nto SRP compared to SRP alone.\nMethods: The PubMed-MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to November 2014\nto identify appropriate studies. Probing Pocket Depth (PD), Clinical Attachment Level (CAL), Bleeding on Pocket\nProbing(BOP) and Plaque Indices(PI) were selected as outcome variables. Based on the extracted data a meta-analysis\nwas conducted.\nResults: A total of 526 unique articles were found, 20 studies met the eligibility criteria. A meta-analysis showed that\nSRP + amx + met provided significantly better effects overall and more pronounced PD reduction in periodontal\npockets initially measuring �6 mm (DiffM:-0.86 mm, p < 0.00001) and gain in CAL(DiffM:+0.75 mm,\np = 0.0001). The meta-analysis for the secondary inflammatory parameter BOP showed that SRP + amx + met provided\nfull mouth significantly greater reduction in BOP than SRP alone (DiffM:-6.98 %, p = 0.0001).\nConclusion: Adjunctive systemic amoxicillin and metronidazole medication to SRP significantly improved the clinical\noutcomes with respect to mean PD, CAL and BOP compared to SRP alone. There is moderate to strong evidence in\nsupport of the recommendation that adjunctive amx +met therapy to SRP significantly improves the clinical outcomes,\nwith respect to mean PD and CAL compared to SRP alone especially in initially deep (�6 mm) pockets. No major side\neffects associated with the intake of amx + met were reported. This treatment regimen is an efficacious, minimally\ninvasive, practical and inexpensive approach for periodontitis therapy. The key components are mechanical tooth and\npocket debridement, supportive treatment of the disease with systemic antibiotics and attention to proper self-care.
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