Local versus systemic adjunctive antibiotic therapy in 28 patients with generalized aggressive periodontitis

Background: Although the use of systemic antibiotics has been studied in pa tients with generalized aggressive periodontitis (formerly rapidly progress ive periodontitis), the use of adjunctive tetracycline fibers in these pati ents has not been reported. The purpose of the present study was to compare the clinical response of local versus systemic antibiotic treatment as adj uncts to scaling and root planing in patients with GAgP. Methods: After initial therapy and full-mouth scaling and root planing (SRP ), 30 patients were randomly assigned to 1 of 2 antibiotic treatment groups . Probing depth (PD), clinical attachment level (CAL), and bleeding on prob ing (BOP) were recorded with an automated probe prior to SRP at baseline (B L) and 15, 30, 41, and 54 weeks later. Three months after SRP, the patients were treated with amoxicillin/clavulanic acid (500 mg tid; SRP + AUG group ) or with local tetracycline fiber in pockets with PD greater than or equal to5 mm (SRP + TCF group). Results: In both treatment groups, PD decreased significantly from BL to we ek 54 (6.2 +/- 1.5 mm to 4.7 +/- 1.4 mm for SRP + TCF and 6.5 +/- 1.4 mm to 4.2 +/- 0.6 mm for SRP + AUG). However, there was no statistically signifi cant difference between the 2 groups in pocket reduction. Similarly, in bot h treatment groups, there were small but significant gains in CAL from BL t o week 54 (12.0 +/- 1.8 mm to 11.3 +/- 1.8 mm for SRP + TCF and 12.3 +/- 1. 5 mm to 11.2 +/- 1.2 mm for SRP + AUG). The difference in CAL gain between the 2 groups was not statistically significant. At the final examination, b oth groups showed significant PD reduction and CAL gain (P <0.001) compared to BL. The frequency and percentage of bleeding sites decreased significan tly in both groups. At week 54, this decrease was significantly greater in the SRP + AUG group (31.67% for SRP + TCF versus 3.85% for SRP + AUG). Conclusions: These results indicate that the local delivery of tetracycline by a fiber or the systemic administration of amoxicillin/clavulanic acid g iven 3 months after scaling and root planing produced similar clinical outc omes over the 9-month observation period.