The supplemental use of antibiotics in periodontal therapy

Many antibiotics and other chemotherapeutic agents have been used as adjuncts to mechanical periodontal therapy with mixed results. This article reviews the clinical and microbial results obtained after the systemic administration of tetracyclines, penicillins, clindamycin, and metronidazole, as well as the combination of metronidazole and Augmentin as adjuncts to conventional periodontal treatment. The major adverse effects associated with each of these antibiotics are given, as well as the potential for the emergence of antibiotic resistance in the periodontal flora. Recently, the introduction of a new generation of controlled-release, locally applied antimicrobial agents provides the clinician with the opportunity to treat individual periodontal sites with high concentrations of medication. The clinical effects obtained from multicenter clinical trials with PerioChip, which contains chlorhexidine, and with Atridox, which contains doxycycline, are summarized. Finally, suggestions are given both for the selection of an antimicrobial agent and for minimizing the development of antibiotic resistance in the periodontal flora.