Abstract
To collate the literature evaluating the efficacy of clarithromycin as an adjunct to non-surgical periodontal therapy and conduct meta-analyses for changes in probing pocket depth (PPD) and clinical attachment level (CAL). Five electronic databases were searched from inception to May 2020 (PubMed, Cochrane CENTRAL, EMBASE via OVID, Web of Science and OpenGrey). Clinical outcomes were extracted, pooled and meta-analyses conducted using mean difference with standard deviations. Systemic delivery: 0.65mm (95% CI: 0.02 to 1.27mm) mean additional PPD reduction was observed at 3months and 0.28mm (95% CI: -0.32 to 0.87mm) at 6months. 0.41mm (95% CI: -0.12 to 0.95mm) mean additional CAL gain was observed at 3months, and 0.16mm (95% CI: -0.41 to 0.74mm) at 6months. Increased risk of adverse events was observed; RR: 5.13 (95% CI: 0.63 to 41.98). Local delivery: 1.01mm (95% CI: 0.84 to 1.17mm) mean additional PPD reduction was observed at 3months, and 1.20mm (95% CI: 0.76 to 1.64mm) at 6months. 0.56mm (95% CI: 0.46 to 0.66mm) mean additional CAL gain was observed at 3months, and 0.83mm (95% CI: 0.65 to 1.02mm) at 6months. No adverse events were observed. The use of locally delivered clarithromycin significantly improves treatment outcomes.
Highlights
| INTRODUCTIONPeriodontitis is a chronic inflammatory disease modulated by host- bacteria interactions and characterized by loss of attachment. Management of the disease centres around eliminating the pathogenic microbiota, with a view to dampen the inflammatory response and promote healing. Non-surgical periodontal therapy forms the cornerstone of treatment; mechanical debridement of the root surface has been shown to be efficacious, inducing improvements in clinical outcomes. If managed inappropriately, the disease leads to loss of the affected dentition, and untreated periodontal disease stands as the most common cause of tooth loss. In addition, the detrimental effects of the disease extend beyond the oral cavity, and periodontitis has been associated with a number of other chronic, non-communicable, inflammatory conditions, such as diabetes mellitus, cardiovascular disease, chronic kidney disease and chronic obstructive pulmonary disease.5-8
Systemic delivery: 0.65 mm mean additional probing pocket depth (PPD) reduction was observed at 3 months and 0.28 mm at 6 months. 0.41 mm mean additional clinical attachment level (CAL) gain was observed at 3 months, and 0.16 mm at 6 months
Local delivery: 1.01 mm mean additional PPD reduction was observed at 3 months, and 1.20 mm at 6 months. 0.56 mm mean additional CAL gain was observed at 3 months, and 0.83 mm at 6 months
Summary
Periodontitis is a chronic inflammatory disease modulated by host- bacteria interactions and characterized by loss of attachment. Management of the disease centres around eliminating the pathogenic microbiota, with a view to dampen the inflammatory response and promote healing. Non-surgical periodontal therapy forms the cornerstone of treatment; mechanical debridement of the root surface has been shown to be efficacious, inducing improvements in clinical outcomes. If managed inappropriately, the disease leads to loss of the affected dentition, and untreated periodontal disease stands as the most common cause of tooth loss. In addition, the detrimental effects of the disease extend beyond the oral cavity, and periodontitis has been associated with a number of other chronic, non-communicable, inflammatory conditions, such as diabetes mellitus, cardiovascular disease, chronic kidney disease and chronic obstructive pulmonary disease.5-8. Clarithromycin has a number of beneficial properties for management of bacterial conditions, such as a high oral bioavailability combined with an extended plasma half-life allowing for lower dosages to be used, lipophilic properties resulting in enhanced tissue penetration, structural modifications to its lactone ring which make it immune to acid- induced inactivation, and potency against a wide spectrum of bacterial species.. Clarithromycin has a number of beneficial properties for management of bacterial conditions, such as a high oral bioavailability combined with an extended plasma half-life allowing for lower dosages to be used, lipophilic properties resulting in enhanced tissue penetration, structural modifications to its lactone ring which make it immune to acid- induced inactivation, and potency against a wide spectrum of bacterial species.14 This combination of properties makes clarithromycin a promising drug for the management of periodontal disease. The primary outcomes being assessed were change in probing pocket depth (PPD) and clinical attachment level (CAL)
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