Comparação entre dois protocolos antibióticos como adjuvantes ao debridamento periodontal ultrassônico de boca toda no tratamento de periodontite agressiva generalizada: estudo clínico controlado randomizado
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Data
2017-01-17
Autores
Araujo, Cássia Fernandes [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A periodontite agressiva generalizada é uma condição periodontal que frequentemente requer a associação da terapia mecânica - raspagem e alisamento radicular (RAR) - com o uso de agentes antimicrobianos para um melhor resultado no tratamento da doença. Diversos estudos demonstram a eficácia da associação entre amoxicilina (AMX) e metronidazol (MET) como agentes adjuvantes a RAR. Em contrapartida, a literatura aponta que a extensiva utilização desses antimicrobianos poderia gerar resistência bacteriana. Visando novos protocolos, o presente estudo clínico controlado randomizado teve como objetivo comparar a resposta clínica periodontal e os possíveis efeitos adversos da utilização de AMX + MET versus claritromicina (CLM) associados ao debridamento periodontal ultrassônico de boca toda em sessão única (DPU) no tratamento de pacientes com periodontite agressiva generalizada (PAgG). Para tal, foram selecionados 46 pacientes apresentando PAgG, os quais foram distribuídos aleatoriamente em dois grupos: grupo AMX + MET (n=23): DPU associado a amoxicilina (500 mg – 8/8 h) e metronidazol (400 mg – 8/8 h) durante 7 dias; e grupo CLM (n=23): DPU associado à claritromicina (500 mg – 12/12 h) durante 7 dias. Foram avaliados os efeitos adversos relacionados à utilização dos antibióticos, bem como os parâmetros clínicos de profundidade de sondagem (PS), nível de inserção clínica (NIC), recessão gengival (RG), índice gengival (IG) e índice de placa (IP) no baseline, 3 e 6 meses após o procedimento. Os resultados revelaram que ambos os protocolos promoveram melhora estatisticamente significante em todos os parâmetros clínicos em comparação com o baseline, sem diferença na ocorrência de efeitos adversos. Assim, pode-se inferir que a CLM tem a mesma eficácia do que a associação AMX + MET como adjuvante ao DPU e pode ser uma alternativa no tratamento de periodontite agressiva generalizada. (ClinicalTrials.gov: NCT02969928)
Generalized aggressive periodontitis is a periodontal condition that may require the association of mechanical therapy - scaling and root planning (SRP) - with the use of antimicrobial agents to obtain a better result in treating the disease. Several studies show the effectiveness of the use of amoxicillin (AMX) and metronidazole (MET) associated with SRP. However, the literature has already pointed that the extensive use of these antimicrobials could generate bacterial resistance. In order to evaluate new approaches, the present controlled randomized clinical trial aimed to assess the periodontal clinical response and the possible adverse effects of AMX + MET versus clarithromycin (CLM) combined to full-mouth ultrasonic debridement (FMUD) in the treatment of patients with generalized aggressive periodontitis (GAgP). To this, forty-six (46) patients with GAgP were selected and randomly assigned into two groups: AMX + MET group (n=23): FMUD associated with amoxicillin (500 mg – 8/8 h) and metronidazole (400 mg – 8/8 h) for 7 days; and CLM group (n=23): FMUD associated with clarithromycin (500 mg – 12/12 h) for 7 days. Probing depth (PD), clinical attachment level (CAL), gingival recession (GR), gingival index (GI) and full-mouth plaque index (FMPI) were evaluated at baseline, 3 and 6 months post-operatively. The adverse effects resulted from antibiotic intake were also evaluated. The results revealed that both treatments led to statistically significant improvement in all clinical parameters compared to baseline, with no difference regarding the occurrence of advese effects. Thus, it can be inferred that CLM has the same efficacy than the AMX + MET association and may be an alternative in the treatment of generalized aggressive periodontitis. (ClinicalTrials.gov: NCT02969928)
Generalized aggressive periodontitis is a periodontal condition that may require the association of mechanical therapy - scaling and root planning (SRP) - with the use of antimicrobial agents to obtain a better result in treating the disease. Several studies show the effectiveness of the use of amoxicillin (AMX) and metronidazole (MET) associated with SRP. However, the literature has already pointed that the extensive use of these antimicrobials could generate bacterial resistance. In order to evaluate new approaches, the present controlled randomized clinical trial aimed to assess the periodontal clinical response and the possible adverse effects of AMX + MET versus clarithromycin (CLM) combined to full-mouth ultrasonic debridement (FMUD) in the treatment of patients with generalized aggressive periodontitis (GAgP). To this, forty-six (46) patients with GAgP were selected and randomly assigned into two groups: AMX + MET group (n=23): FMUD associated with amoxicillin (500 mg – 8/8 h) and metronidazole (400 mg – 8/8 h) for 7 days; and CLM group (n=23): FMUD associated with clarithromycin (500 mg – 12/12 h) for 7 days. Probing depth (PD), clinical attachment level (CAL), gingival recession (GR), gingival index (GI) and full-mouth plaque index (FMPI) were evaluated at baseline, 3 and 6 months post-operatively. The adverse effects resulted from antibiotic intake were also evaluated. The results revealed that both treatments led to statistically significant improvement in all clinical parameters compared to baseline, with no difference regarding the occurrence of advese effects. Thus, it can be inferred that CLM has the same efficacy than the AMX + MET association and may be an alternative in the treatment of generalized aggressive periodontitis. (ClinicalTrials.gov: NCT02969928)
Descrição
Palavras-chave
Periodontite agressiva, Claritromicina, Amoxicilina, Metronidazol, Debridamento periodontal, Antibióticos, Efeitos adversos, Aggressive periodontitis, Amoxicillin, Metronidazole, Clarithromycin, Anti-infective agents, Periodontal debridement, Adverse effects