Download PDF
Zahnmedizin up2date 2022; 16(03): 269-284
DOI: 10.1055/a-1842-3641
Parodontologie

Antibiotika in der parodontalen Therapie

Karin Jepsen
,
Raluca Cosgarea
,
Pia-Merete Jervøe-Storm
› Further Information
Also available at
    Permissions and Reprints All articles of this category

Aufgrund der Rolle von Bakterien in der Ätiopathogenese der Parodontitis kommen Antibiotika in der Parodontologie bereits seit mehreren Jahrzehnten zum Einsatz. Eine sorgfältige Nutzen-Risiko-Abwägung hinsichtlich möglicher Nebenwirkungen und insbesondere Resistenzbildungen spielt heute eine sehr wichtige Rolle bei der Indikationsstellung. Dieser Beitrag fasst den aktuellen Stand vor dem Hintergrund neuer Erkenntnisse und Empfehlungen zusammen.
Kernaussagen

  • Systemische Antibiotika sollen bei Parodontitispatienten nicht routinemäßig zusätzlich zur subgingivalen Instrumentierung eingesetzt werden.

  • In einer Nutzen-Risiken-Analyse überwiegen Bedenken hinsichtlich unerwünschter Nebenwirkungen für den Patienten und Förderung der Antibiotikaresistenzen in der Bevölkerung.

  • Die adjuvante Verwendung bestimmter Antibiotika (Metronidazol mit oder ohne Amoxicillin) in der Therapiestufe 2 kann für bestimmte Patientengruppen mit nachgewiesener rascher Progression (z. B. generalisierte Stadien III/IV der Parodontitis bei jungen Erwachsenen) erwogen werden.

  • Die Behandlung dieser speziellen Hochrisikopatienten sollte idealerweise von Spezialist*innen durchgeführt werden (DG PARO-Spezialist oder Fachzahnarzt für Parodontologie).

  • Die Indikation und die Beurteilung des Behandlungserfolgs orientieren sich am klinischen Bild und nicht am Ergebnis mikrobiologischer Diagnostik.

  • Eine systemische Antibiotikagabe bei Parodontitispatienten darf keineswegs Ersatz für eine unzureichende subgingivale Instrumentierung oder mangelhafte Mundhygiene sein.

  • Der Nutzen einer perioperativen Antibiotikaprophylaxe bei parodontalchirurgischen Eingriffen oder aber derjenige einer systemischen antibiotischen Begleittherapie bei regenerativ-chirurgischen Eingriffen ist nicht erwiesen.

  • Bestimmte lokal applizierte Antibiotika mit anhaltender Freisetzung können bei Parodontitispatienten zusätzlich zur subgingivalen Instrumentierung erwogen werden.

  • Ihr Einsatz ist nur bei Patienten mit wenigen lokalisierten tiefen Taschen und bei sehr guter Mundhygiene sinnvoll, da andernfalls eine rasche Reinfektion stattfindet.

  • Akute parodontale Zustände (Taschenabszesse mit Ausbreitungstendenz beziehungsweise ulzerierende Parodontalerkrankungen) können eine systemische Antibiotikagabe erforderlich machen.

Schlüsselwörter

Schwere Parodontitis - adjuvante Antibiotika - aktuelle Behandlungsleitlinien


Publication History

Article published online:
22 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Jepsen S, Dommisch H, Kebschull M. Ätiologie der Parodontitis: Gibt es neue Erkenntnisse?. zm 2018; 108: 66
    Search in Google Scholar
  • 2 Kilian M, Chapple IL, Hannig M. et al. The oral microbiome – an update for oral healthcare professionals. Br Dent 2016; 221: 657-666
    CrossrefPubMedSearch in Google Scholar
  • 3 Rupf S, Hannig M. Das humane Mikrobiom und seine Bedeutung für die Zahnmedizin. zm 2020; 110: 2292
    Search in Google Scholar
  • 4 Hagenfeld D, Prior K, Ehmke B. Das parodontalpathogene Mikrobiom bei Parodontitispatienten. zm 2021; 111: 42
    Search in Google Scholar
  • 5 Mombelli A. Antimicrobial Advances in treating periodontal Diseases. In: Kinane DF, Mombelli A. eds. Frontiers of oral Biology: periodontal Disease. Basel: Karger AG; 2012: 133-148
    CrossrefSearch in Google Scholar
  • 6 Wollkopf AD, Mutters NT. Antibiotikaresistenzen – die stille Pandemie. zm 2022; 112: 954
    Search in Google Scholar
  • 7 Cosgarea R, Wenzel S, Jepsen K. Systemische Antibiotika in der Parodontaltherapie: Nutzen und Risiken. zm 2022; 112: 36-41
    Search in Google Scholar
  • 8 Herrera D, Sanz M, Jepsen S. et al. A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients. J Clin Periodontol 2002; 29 (Suppl. 03) 136-159
    CrossrefPubMedSearch in Google Scholar
  • 9 Haffajee AD, Socransky SS, Gunsolley JC. Systemic anti-infective periodontal therapy. A systematic review. Ann Periodontol 2003; 8: 115-181
    CrossrefPubMedSearch in Google Scholar
  • 10 Herrera D, Contreras A, Gamonal J. et al. Subgingival microbial profiles in chronic periodontitis patients from Chile, Colombia and Spain. J Clin Periodontol 2008; 35: 106-113
    CrossrefPubMedSearch in Google Scholar
  • 11 Sgolastra F, Petrucci A, Gatto R, Monaco A. Effectiveness of systemic amoxicillin/metronidazole as an adjunctive therapy to full-mouth scaling and root planing in the treatment of aggressive periodontitis: a systematic review and meta-analysis. J Periodontol 2012; 83: 731-743
    CrossrefPubMedSearch in Google Scholar
  • 12 Sgolastra F, Gatto R, Petrucci A. et al. Effectiveness of systemic amoxicillin/metronidazole as adjunctive therapy to scaling and root planing in the treatment of chronic periodontitis: a systematic review and meta-analysis. J Periodontol 2012; 83: 1257-1269
    CrossrefPubMedSearch in Google Scholar
  • 13 Keestra JA, Grosjean I, Coucke W. et al. Non-surgical periodontal therapy with systemic antibiotics in patients with untreated chronic periodontitis: a systematic review and meta-analysis. J Periodontal Res 2015; 50: 294-314
    CrossrefPubMedSearch in Google Scholar
  • 14 Keestra JA, Grosjean I. Coucke. et al. Non-surgical periodontal therapy with systemic antibiotics in patients with untreated aggressive periodontitis: a systematic review and meta-analysis. J Periodontal Res 2015; 50: 689-706
    CrossrefPubMedSearch in Google Scholar
  • 15 Zandbergen D, Slot DE, Cobb CM. et al. The clinical effect of scaling and root planing and the concomitant administration of systemic amoxicillin and metronidazole: a systematic review. J Periodontol 2013; 84: 332-351
    CrossrefPubMedSearch in Google Scholar
  • 16 Teughels W, Feres M, Oud V. et al. Adjunctive effect of systemic antimicrobials in periodontitis therapy. A systematic review and meta-analysis. J Clin Periodontol 2020; 47 (Suppl. 22) 257-281
    CrossrefPubMedSearch in Google Scholar
  • 17 Harks I, Koch R, Eickholz P. et al. Is progression of periodontitis relevantly influenced by systemic antibiotics? A clinical randomized trial. J Clin Periodontol 2015; 42: 832-842
    CrossrefPubMedSearch in Google Scholar
  • 18 Eickholz P, Koch R, Kocher T. et al. Clinical benefits of systemic amoxicillin/metronidazole may depend on periodontitis severity and patientsʼ age: An exploratory sub-analysis of the ABPARO trial. J Clin Periodontol 2019; 46: 491-501
    CrossrefPubMedSearch in Google Scholar
  • 19 Jepsen K, Jepsen S. Antibiotics/antimicrobials: systemic and local administration in the therapy of mild to moderately advanced periodontitis. Periodontol 2000 2016; 71: 82-112
    CrossrefPubMedSearch in Google Scholar
  • 20 McGowan K, McGowan T, Ivanovski S. Optimal dose and duration of amoxicillin-plus-metronidazole as an adjunct to non-surgical periodontal therapy: A systematic review and meta-analysis of randomized, placebo-controlled trials. J Clin Periodontol 2018; 45: 56-67
    CrossrefPubMedSearch in Google Scholar
  • 21 Pretzl B, Salzer S, Ehmke B. et al. Administration of systemic antibiotics during non-surgical periodontal therapy-a consensus report. Clin Oral Investig 2019; 23: 3073-3085
    CrossrefPubMedSearch in Google Scholar
  • 22 Cosgarea R, Juncar R, Heumann C. et al. Non-surgical periodontal treatment in conjunction with 3 or 7 days systemic administration of amoxicillin and metronidazole in severe chronic periodontitis patients. A placebo-controlled randomized clinical study. J Clin Periodontol 2016; 43: 767-777
    CrossrefPubMedSearch in Google Scholar
  • 23 Cosgarea R, Heumann C, Juncar R. et al. One year results of a randomized controlled clinical study evaluating the effects of non-surgical periodontal therapy of chronic periodontitis in conjunction with three or seven days systemic administration of amoxicillin/metronidazole. PLoS One 2017; 12: e0179592
    CrossrefPubMedSearch in Google Scholar
  • 24 Cosgarea R, Eick S, Jepsen S. et al. Microbiological and host-derived biomarker evaluation following non-surgical periodontal therapy with short-term administration of systemic antimicrobials: secondary outcomes of an RCT. Sci Rep 2020; 10: 16322
    CrossrefPubMedSearch in Google Scholar
  • 25 Cosgarea R, Jepsen S, Heumann C. et al. Clinical, microbiological and immunological effects of 3- or 7-day systemic antibiotics adjunctive to subgingival instrumentation in patients with aggressive (stage III/IV grade C) periodontitis: a randomized placebo-controlled clinical trial. J Clin Periodontol 2022;
    CrossrefPubMedSearch in Google Scholar
  • 26 Martin JSH, Monaghan TM, Wilcox MH. Clostridium difficile infection: epidemiology, diagnosis and understanding transmission. Nat Rev Gastroenterol Hepatol 2016; 13: 206-216
    CrossrefPubMedSearch in Google Scholar
  • 27 Sartelli M, Di Bella S, McFarland LV. et al. 2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients. World J Emerg Surg 2019; 14: 8
    CrossrefPubMedSearch in Google Scholar
  • 28 World Health Organization. Global antimicrobial resistance and use surveillance system (GLASS) report: 2021. Im Internet (Stand: 12.08.2022): https://www.who.int/publications/i/item/97892400
  • 29 Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022; 399: 629-655
    Search in Google Scholar
  • 30 Jepsen K, Falk W, Brune F. et al. Prevalence and Antibiotic Susceptibility Trends of Selected Enterobacteriaceae, Enterococci, and Candida albicans in the Subgingival Microbiota of German Periodontitis Patients: A Retrospective Surveillance Study. Antibiotics (Basel) 2022; 11: 385
    CrossrefPubMedSearch in Google Scholar
  • 31 Cassini A, Högberg LD, Plachouras D. et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis 2019; 19: 56-66
    CrossrefPubMedSearch in Google Scholar
  • 32 Jepsen K, Falk W, Brune F. et al. Prevalence and antibiotic susceptibility trends of periodontal pathogens in the subgingival microbiota of German periodontitis patients: A retrospective surveillance study. J Clin Periodontol 2021; 48: 1216-1227
    CrossrefPubMedSearch in Google Scholar
  • 33 Sanz M, Herrera D, Kebschull M. et al. Treatment of stage I–III periodontitis-The EFP S3 level clinical practice guideline. J Clin Periodontol 2020; 47 Suppl 22: 4-60
    CrossrefPubMedSearch in Google Scholar
  • 34 Dyar OJ, Huttner B, Schouten J. et al. ESGAP (ESCMID Study Group for Antimicrobial stewardshiP). What is antimicrobial stewardship?. Clin Microbiol Infect 2017; 23: 793-798
    CrossrefPubMedSearch in Google Scholar
  • 35 Liu Y, Duan D, Xin Y. et al. A review of the literature: antibiotic usage and its relevance to the infection in periodontal flaps. Acta Odontol Scand 2017; 75: 288-293
    CrossrefPubMedSearch in Google Scholar
  • 36 Hai JH, Lee C, Kapila YL. et al. Antibiotic prescribing practices in periodontal surgeries with and without bone grafting. J Periodontol 2020; 91: 508-515
    CrossrefPubMedSearch in Google Scholar
  • 37 Eckmann C. Perioperative Antibiotikaprophylaxe. Im Internet (Stand: 25.07.2022): https://www.bdc.de/category/wissen/qualitatpatientensicherheit/%22%3ehttps://www.bdc.de/category/wissen/qualitatpatientensicherheit/%3c/uri%3e
  • 38 Powell CA, Mealey BL, Deas DE. et al. Post-surgical infections: prevalence associated with various periodontal surgical procedures. J Periodontol 2005; 76: 329-333
    CrossrefPubMedSearch in Google Scholar
  • 39 Mohan RR, Doraswamy DC, Hussain AM. et al. Evaluation of the role of antibiotics in preventing postoperative complication after routine periodontal surgery: A comparative clinical study. J Indian Soc Periodontol 2014; 18: 205-212
    CrossrefPubMedSearch in Google Scholar
  • 40 Collins JR, Ogando G, Gonzalez R. et al. Adjunctive efficacy of systemic metronidazole in the surgical treatment of periodontitis: a double-blind parallel randomized clinical trial. Clin Oral Investig 2022; 26: 4195-4207
    CrossrefPubMedSearch in Google Scholar
  • 41 Nibali L, Koidou VP, Nieri M. et al. Regenerative surgery versus access flap for the treatment of intra-bony periodontal defects: A systematic review and meta-analysis. J Clin Periodontol 2020; 47 Suppl 22: 320-351
    CrossrefPubMedSearch in Google Scholar
  • 42 Jepsen S, Gennai S, Hirschfeld J. et al. Regenerative surgical treatment of furcation defects: A systematic review and Bayesian network meta-analysis of randomized clinical trials. J Clin Periodontol 2020; 47: 352-374
    CrossrefPubMedSearch in Google Scholar
  • 43 Nibali L, Buti J, Barbato L. et al. Adjunctive Effect of Systemic Antibiotics in Regenerative/Reconstructive Periodontal Surgery-A Systematic Review with Meta-Analysis. Antibiotics 2022; 11: 8
    CrossrefPubMedSearch in Google Scholar
  • 44 Loos BG, Louwerse PHG, Van Winkelhoff AJ. et al. Use of barrier membranes and systemic antibiotics in the treatment of intraosseous defects. J Clin Periodontol 2002; 29: 910-921
    CrossrefPubMedSearch in Google Scholar
  • 45 Abu-Taʼa M. Adjunctive Systemic Antimicrobial Therapy vs. Asepsis in Conjunction with Guided Tissue Regeneration: A Randomized, Controlled Clinical Trial. J Contemp Dent Pract 2016; 17: 3-6
    CrossrefPubMedSearch in Google Scholar
  • 46 Eickholz P, Rollke L, Schacher B. et al. Enamel matrix derivative in propylene glycol alginate for treatment of infrabony defects with or without systemic doxycycline: 12- and 24-month results. J Periodontol 2014; 85: 669-675
    CrossrefPubMedSearch in Google Scholar
  • 47 Pietruska M, Dolinska E, Milewski R, Sculean A. Effect of systemic antibiotics on the outcomes of regenerative periodontal surgery in intrabony defects: a randomized, controlled, clinical study. Clin Oral Investig 2021; 25: 2959-2968
    CrossrefPubMedSearch in Google Scholar
  • 48 Goodson JM, Cugini MA, Kent RL. et al. Multicenter evaluation of tetracycline fiber therapy: I. Experimental design, methods, and baseline data. J Periodontal Res 1991; 26: 361-370
    CrossrefPubMedSearch in Google Scholar
  • 49 Goodson JM, Cugini MA, Kent RL. et al. Multicenter evaluation of tetracycline fiber therapy: II. Clinical response. J Periodontal Res 1991; 26: 371-379
    CrossrefPubMedSearch in Google Scholar
  • 50 Hanes PJ, Purvis JP. Local anti-infective therapy: pharmacological agents. A systematic review. Ann Periodontol 2003; 8: 79-98
    CrossrefPubMedSearch in Google Scholar
  • 51 Bonito AJ, Lux L, Lohr KN. Impact of local adjuncts to scaling and root planing in periodontal disease therapy: a systematic review. J Periodontol 2005; 76: 1227-1236
    CrossrefPubMedSearch in Google Scholar
  • 52 Matesanz-Perez P, Garcia-Gargallo M, Figuero E. et al. A systematic review on the effects of local antimicrobials as adjuncts to subgingival debridement, compared with subgingival debridement alone, in the treatment of chronic periodontitis. J Clin Periodontol 2013; 40: 227-241
    CrossrefPubMedSearch in Google Scholar
  • 53 Smiley CJ, Tracy SL, Abt E. et al. Systematic review and meta-analysis on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. J Am Dent Assoc 2015; 146: 508-524.e5
    CrossrefPubMedSearch in Google Scholar
  • 54 Herrera D, Retamal-Valdes B, Alonso B. et al. Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo-periodontal lesions. J Clin Periodontol 2018; 45 (Suppl. 20) S78-S94
    CrossrefPubMedSearch in Google Scholar
  • 55 Papapanou PN, Sanz M, Buduneli N. et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol 2018; 89: S173-S182
    CrossrefPubMedSearch in Google Scholar
  • 56 Herrera D, Alonso B, de Arriba L. et al. Acute periodontal lesions. Periodontol 2000 2014; 65: 149-177
    CrossrefPubMedSearch in Google Scholar