Empiric or individually targeted antimicrobial therapy. Historical perspective and current state

Area of Science:

• Periodontology
• Microbiology
• Pharmacology

Background:

• Current periodontal therapy relies on population data and broad-spectrum antibiotics (e.g., amoxicillin/metronidazole).
• This approach risks disrupting oral and gut microbiota, potentially increasing antimicrobial resistance.
• Treatment decisions are guided by disease severity and progression risk markers.

Purpose of the Study:

• To evaluate the rationale for empirical versus individualized antimicrobial use in periodontal therapy.
• To assess the clinical efficacy and risks of current empirical protocols.
• To explore the potential of personalized antimicrobial strategies.

Main Methods:

• A critical literature review was conducted.
• Assessed clinical efficacy and risks of empirical protocols.
• Explored potential of personalized antimicrobial strategies.

Main Results:

• Clinical trials show inconsistent superior outcomes for microbiologically or biologically guided therapy.
• Cost-effectiveness and patient benefit of specialized testing remain unclear.
• Individual variability in pathogens, microbiome, host response, and pharmacology supports personalized approaches.
• Advances in personalized medicine (genetics, biomarkers, ML) enable data integration for targeted interventions.

Conclusions:

• Future periodontal therapy will likely integrate population-based evidence with individualized treatment planning.
• A hybrid model combining guidelines with patient-specific data aims to enhance outcomes.
• This reflects a shift toward precision medicine in periodontal practice.