A Systematic Review of Clinical Efficacy of Adjunctive Antibiotics in the Treatment of Smokers With Periodontitis

Background: The aim of this study is to systematically review the evidence of the efficacy of adjunctive antibiotic therapy to periodontal therapy in smokers with periodontitis. Methods: A search was conducted for randomized clinical trials (RCTs) with durations >= 6 months that compared periodontal therapy with and without adjunctive antibiotics for the treatment of periodontitis in smokers. Data sources primarily included PubMed with MeSH terms and free text as well as EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Clinical Trials. In addition, a hand search of selected periodontal journals, bibliographies, and review articles was conducted. Independent reviewers were assigned to make independent searches and quality assessments (MA and DB) of the included studies, and disagreements were resolved by discussion. Results: Five RCTs were selected for quantitative and qualitative assessments. Little evidence was found that supported the use of antibiotic therapy in conjunction with surgical periodontal therapy in smokers. With respect to non-surgical therapy, consistent improvements in clinical attachment level (CAL) gain and probing depth (PD) reduction was reported after the use of a 250-mg azithromycin tablet in one study. Adjunctive doxycycline gel and minocycline microspheres statistically improved CAL gain (in one RCT) and PD reduction (in one RCT), respectively. However, the risk of bias in all studies was estimated as high. Also, inadequate and inconsistent data precluded performing meta-analyses. Conclusions: The present systematic review concludes that the evidence for an additional benefit of adjunctive antibiotic therapy in smokers with chronic periodontitis is insufficient and inconclusive. Additional well-designed RCTs are required to assess the effect of antibiotics in conjunction with periodontal treatments in smokers. J Periodontol 2010;81:1518-1528.