Metronidazole and Amoxicillin for the Treatment of Type 2 Diabetic Subjects With Periodontitis

Metronidazole and Amoxicillin as Adjuncts to Scaling and Root Planing for the Treatment of Type 2 Diabetic Subjects With Periodontitis: a Randomized Placebo-controlled Clinical Trial

Diabetes mellitus (DM) is a widely prevalent disease associated with several major systemic and oral complications, such as periodontitis. The use of adjunctive local and/or systemic antimicrobials has been proposed to improve the clinical and glycemic outcomes of the scaling and root planing (SRP) in diabetic subjects. The combination of metronidazole (MTZ) and amoxicillin (AMX) has been largely recognized as an effective therapy for improving the clinical and microbiological outcomes of SRP in the treatment of with chronic periodontitis (ChP). However, no previous clinical trials to date have evaluated the effects of this antibiotic combination in the treatment of diabetic subjects with periodontitis. Therefore, the aim of this randomized clinical trial (RCT) will be to evaluate the clinical and microbiological effects of the use of MTZ+AMX as adjuncts to SRP for the treatment of type 2 diabetic subjects with generalized ChP.

Inclusion Criteria:

• ≥ 35 years of age
• Diagnosis of type 2 DM for ≥ 5 years
• DM treatment with diet and insulin supplementation or oral hypoglycemic agents
• Glycated hemoglobin (HbA1c) levels ≥ 6.5% ≤ 11%
• At least 15 teeth
• More than 30% of the sites with probing depth (PD) and clinical attachment level (CAL) ≥ 4 mm
• Minimum of six teeth with at least one site with PD and CAL ≥ 5 mm and bleeding on probing (BoP) at baseline.

Exclusion Criteria:

• Pregnancy
• Lactation
• Current smoking
• Smoking within the past 5 years
• Scaling and root planing (SRP) in the previous 12 months
• Antimicrobial therapies during the previous 6 months
• Medical conditions requiring prophylactic antibiotic coverage
• Continuous use of mouthrinses containing antimicrobials in the preceding 3 months
• Systemic conditions (except DM) that could affect the progression of periodontitis (e.g. immunological disorders, osteoporosis)
• Long-term administration of anti-inflammatory
• Long-term administration of immunosuppressive medications
• Allergy to metronidazole and/or amoxicillin
• Presence of periapical pathology
• Use of orthodontic appliances
• Presence of extensive prosthetic rehabilitation
• Major complications of DM (i.e. cardiovascular and peripheral vascular diseases [ulcers, gangrene and amputation], neuropathy and nephropathy)