Comparing the Antimicrobial In Vitro Efficacy of Amoxicillin/Metronidazole against Azithromycin-A Systematic Review

Area of Science:

• Periodontology
• Microbiology
• Pharmacology

Background:

• Systemic amoxicillin and metronidazole are standard adjuncts in periodontal therapy.
• Concerns regarding side effects and compliance drive the search for alternative antibiotics like azithromycin.

Purpose of the Study:

• To systematically review and compare the in vitro antimicrobial efficacy of amoxicillin plus metronidazole versus azithromycin on subgingival biofilm bacteria.

Main Methods:

• A systematic literature search was conducted across major databases (Medline, Embase, Cochrane, Biosis) up to March 2018.
• Included studies evaluated the in vitro antimicrobial activity of amoxicillin + metronidazole or azithromycin on subgingival biofilm bacteria using multispecies biofilm models.
• Three eligible studies, differing in analytical methods and bacterial strains, were included.

Main Results:

• All included studies utilized multispecies biofilm models to assess antimicrobial activity.
• A unanimous finding across studies indicated that amoxicillin plus metronidazole demonstrated more pronounced antimicrobial effects compared to azithromycin.
• The combination of amoxicillin and metronidazole appeared to exhibit higher in vitro antimicrobial efficacy.

Conclusions:

• Based on limited available in vitro data, amoxicillin plus metronidazole shows superior antimicrobial efficacy compared to azithromycin against subgingival biofilm bacteria.
• Further research is warranted to confirm these findings and evaluate clinical implications.