Dose and Duration of Metronidazole and Amoxicillin for Treatment of Chronic Periodontitis

January 8, 2020 updated by: Belén Retamal-Valdes, University of Guarulhos

Impact of Different Dosages and Time of Administration of Metronidazole and Amoxicillin in the Treatment of Generalized Chronic Periodontitis: A Randomized Clinical Trial

The aim of this study was to compare the clinical and microbiological outcomes of different dosages of metronidazole (MTZ) and of the duration of the systemic administration of MTZ and amoxicillin as adjunct to scaling and root planing (SRP) in the treatment of generalized chronic periodontitis (GChP).

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Detailed Description

Randomized clinical trials and systematic reviews have shown that the use of the combination of metronidazole (MTZ) and amoxicillin (AMX) significantly improves the benefits of the SRP in the treatment of subjects with periodontitis. However, the optimal dosage and interval of administration of these antibiotics are still unclear. Therefore, the aim of this study was to compare the clinical and microbiological outcomes of different dosages and duration of the systemic administration of the combination of MTZ and AMX as adjunct to scaling and root planing (SRP) in the treatment of generalized chronic periodontitis (GChP). One hundred ten subjects will be randomly assigned to receive SRP plus placebo, or SRP combined with 250 mg or 400 mg of MTZ, plus AMX (500 mg) TID, for either 7 or 14 days. Subjects will be clinically and microbiologically monitored up to 1 year post-therapy.

Study Type

Interventional

Enrollment (Actual)

110

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Brazil
    • São Paulo
      • Guarulhos, São Paulo, Brazil, 07023-070
        • Guarulhos University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

30 years and older (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • ≥30 years of age;
  • at least 15 teeth (excluding third molars and teeth with advanced decay indicated for extraction)
  • a minimum of 6 teeth with at least one site each with probing depth (PD) and clinical * attachment level (CAL) ≥5 mm;
  • at least 30% of the sites with PD and CAL ≥4 mm and bleeding on probing (BOP).

Exclusion Criteria:

  • pregnancy
  • breastfeeding
  • current smoking and former smoking within the past 5 years;
  • systemic diseases that could affect the progression of periodontitis (e.g. diabetes, immunological disorders, osteoporosis);
  • scaling and root planing an in the previous 12 months;
  • antibiotic therapy in the previous 6 months;
  • long-term intake of anti-inflammatory medications;
  • need for antibiotic pre-medication for routine dental therapy;
  • allergy to metronidazole and/or amoxicillin.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: TREATMENT
  • Allocation: RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: TRIPLE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
PLACEBO_COMPARATOR: Control
Scaling and root planing (SRP) + two placebo pills thrice a day (TID) for 14 days (control group)
Procedure: Scaling and root planing (SRP)
SRP performed in four to six appointments lasting approximately 1 h each, using manual curettes (Hu-Friedy, Chicago, IL, USA) and ultrasonic device (Cavitron Select SPC, Dentsply professional, York, PA, USA) under local anesthesia. The deep sites will be scaled throughout the first week and treatment of the entire oral cavity will be completed in 14 days.
Other: Placebo 400 (14 days)
Subjects will intake placebo of Metronidazole 400 mg. for 14 days, starting immediately after the first session of Scaling and Root Planing.
Other: Placebo 500
Subjects will intake placebo of Amoxicillin 500 mg. for 14 days, starting immediately after the first session of Scaling and Root Planing.
ACTIVE_COMPARATOR: MTZ 250 (7 days)
SRP + MTZ (250mg/TID) + AMX, for 7 days and placebos for another 7 days
Procedure: Scaling and root planing (SRP)
SRP performed in four to six appointments lasting approximately 1 h each, using manual curettes (Hu-Friedy, Chicago, IL, USA) and ultrasonic device (Cavitron Select SPC, Dentsply professional, York, PA, USA) under local anesthesia. The deep sites will be scaled throughout the first week and treatment of the entire oral cavity will be completed in 14 days.
Drug: Metronidazole 250 (7 days)
Subjects will intake Metronidazole 250 mg. for 7 days, starting immediately after the first session of Scaling and Root Planing.
Drug: Amoxicillin
Subjects will intake Amoxicillin 500 mg. for 14 days, starting immediately after and the first session of Scaling and Root Planing.
Other: Placebo 250 (7 days)
Subjects will intake placebo of Metronidazole 250 mg. for 7 days, starting immediately after to intake Metronidazole 250 mg.
ACTIVE_COMPARATOR: MTZ 400 (7 days)
SRP + MTZ (400mg/TID) + AMX, for 7 days and placebos for another 7 days
Procedure: Scaling and root planing (SRP)
SRP performed in four to six appointments lasting approximately 1 h each, using manual curettes (Hu-Friedy, Chicago, IL, USA) and ultrasonic device (Cavitron Select SPC, Dentsply professional, York, PA, USA) under local anesthesia. The deep sites will be scaled throughout the first week and treatment of the entire oral cavity will be completed in 14 days.
Drug: Amoxicillin
Subjects will intake Amoxicillin 500 mg. for 14 days, starting immediately after and the first session of Scaling and Root Planing.
Drug: Metronidazole 400 (7 days)
Subjects will intake Metronidazole 400 mg. for 7 days, starting immediately after the first session of Scaling and Root Planing.
Other: Placebo 400 (7 days)
Subjects will intake placebo of Metronidazole 400 mg. for 7 days, starting immediately after to intake Metronidazole 400 mg.
ACTIVE_COMPARATOR: MTZ 250 (14 days)
SRP +MTZ (250mg/TID) + AMX for 14 days
Procedure: Scaling and root planing (SRP)
SRP performed in four to six appointments lasting approximately 1 h each, using manual curettes (Hu-Friedy, Chicago, IL, USA) and ultrasonic device (Cavitron Select SPC, Dentsply professional, York, PA, USA) under local anesthesia. The deep sites will be scaled throughout the first week and treatment of the entire oral cavity will be completed in 14 days.
Drug: Amoxicillin
Subjects will intake Amoxicillin 500 mg. for 14 days, starting immediately after and the first session of Scaling and Root Planing.
Drug: Metronidazole 250 (14 days)
Subjects will intake Metronidazole 250 mg. for 14 days, starting immediately after the first session of Scaling and Root Planing.
ACTIVE_COMPARATOR: MTZ 400 (14 days)
SRP +MTZ (400mg/TID) + AMX for 14 days
Procedure: Scaling and root planing (SRP)
SRP performed in four to six appointments lasting approximately 1 h each, using manual curettes (Hu-Friedy, Chicago, IL, USA) and ultrasonic device (Cavitron Select SPC, Dentsply professional, York, PA, USA) under local anesthesia. The deep sites will be scaled throughout the first week and treatment of the entire oral cavity will be completed in 14 days.
Drug: Amoxicillin
Subjects will intake Amoxicillin 500 mg. for 14 days, starting immediately after and the first session of Scaling and Root Planing.
Drug: Metronidazole 400 (14 days)
Subjects will intake Metronidazole 400 mg. for 14 days, starting immediately after the first session of Scaling and Root Planing.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Percentage of subjects reaching ≤ 4 periodontal sites with probing depth (PD) ≥ 5 mm at 12 months
Time Frame: 12 months
12 months

Secondary Outcome Measures

Outcome Measure
Time Frame
Percentage of sites with bleeding on probing
Time Frame: Baseline, 3, 6 and 12 months
Baseline, 3, 6 and 12 months
Percentage of sites with plaque accumulation
Time Frame: Baseline, 3, 6 and 12 months
Baseline, 3, 6 and 12 months
Percentage of sites with marginal bleeding
Time Frame: Baseline, 3, 6 and 12 months
Baseline, 3, 6 and 12 months
Number of sites with PD ≥ 5 mm
Time Frame: Baseline, 3, 6 and 12 months
Baseline, 3, 6 and 12 months
Number of sites with PD ≥ 6 mm
Time Frame: Baseline, 3, 6 and 12 months
Baseline, 3, 6 and 12 months
Number of sites with PD ≥ 7 mm
Time Frame: Baseline, 3, 6 and 12 months
Baseline, 3, 6 and 12 months
Reduction in the number of sites with PD ≥ 5 mm
Time Frame: Baseline, 3, 6 and 12 months
Baseline, 3, 6 and 12 months
Reduction in the number of sites with PD ≥ 6 mm
Time Frame: Baseline, 3, 6 and 12 months
Baseline, 3, 6 and 12 months
Reduction in the number of sites with PD ≥ 7 mm
Time Frame: Baseline, 3, 6 and 12 months
Baseline, 3, 6 and 12 months
Full-mouth PD
Time Frame: Baseline, 3, 6 and 12 months
Baseline, 3, 6 and 12 months
Full-mouth clinical attachment level
Time Frame: Baseline, 3, 6 and 12 months
Baseline, 3, 6 and 12 months
Occurrence of headache obtained through a questionnaire of adverse effects
Time Frame: 14 days after the beginning of treatments
14 days after the beginning of treatments
Occurrence of vomiting obtained through a questionnaire of adverse effects
Time Frame: 14 days after the beginning of treatments
14 days after the beginning of treatments
Occurrence of diarrhea obtained through a questionnaire of adverse effects
Time Frame: 14 days after the beginning of treatments
14 days after the beginning of treatments
Occurrence of metallic taste obtained through a questionnaire of adverse effects
Time Frame: 14 days after the beginning of treatments
14 days after the beginning of treatments
Occurrence of nausea obtained through a questionnaire of adverse effects
Time Frame: 14 days after the beginning of treatments
14 days after the beginning of treatments
Occurrence of irritability obtained through a questionnaire of adverse effects
Time Frame: 14 days after the beginning of treatments
14 days after the beginning of treatments
Proportions of periodontal pathogenic bacterial species
Time Frame: Baseline, 3, 6 and 12 months
Baseline, 3, 6 and 12 months
Counts of periodontal pathogenic bacterial species
Time Frame: Baseline, 3, 6 and 12 months
Baseline, 3, 6 and 12 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Guarulhos

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

July 1, 2011

Primary Completion (ACTUAL)

May 1, 2014

Study Completion (ANTICIPATED)

December 1, 2020

Study Registration Dates

First Submitted

March 22, 2016

First Submitted That Met QC Criteria

April 6, 2016

First Posted (ESTIMATE)

April 12, 2016

Study Record Updates

Last Update Posted (ACTUAL)

January 13, 2020

Last Update Submitted That Met QC Criteria

January 8, 2020

Last Verified

January 1, 2020

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • SISNEP/513

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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