Topical and Systemic Antibiotics in the Management of
Adopted by the FDI General Assembly: 18 September 2003
The realisation, over the past three decades or so, of
the microbial specificity of periodontal disease has led to an increasing
use of antimicrobial agents in the management of periodontal infections.
These include systemic antibiotics, topical antibiotics and topical antiseptics.
Despite such frequent use of antibiotics in the management of periodontal
diseases, the literature indicates only a few good controlled trials that
compare the efficacy of adjunctive antibiotic use to mechanical therapy
alone. Currently there is much ongoing research and interest in this topic
amongst the dental profession, especially in view of the global problem
of the emergence of antibiotic resistant organisms. Hence, the knowledge
base on the subject is increasing rapidly and, at the time of writing
FDI takes the following position:
- Scientific evidence indicates that mechanical periodontal treatment
adequate to ameliorate or resolve the clinical condition in a vast majority
patients with periodontal diseases.
- Adjunctive antibiotics should only be used after careful clinical
evaluation of the
condition, being cognisant that unwarranted use may be of negligible
the patient whilst, in the longer term, may promote the emergence of
resistant organisms in the community.
- However, adjunctive antimicrobial agents delivered either locally
may enhance the effect of therapy in specific situations.
- Systemically delivered antibiotics may be considered for aggressive
and refractory) periodontitis and in patients with generalised systemic
that may affect host resistance.
- Locally delivered antibiotics or antiseptics together with mechanical
may be indicated for non-responding sites of local infection or in localised
- The dentist should place the patient on an individually tailored
maintenance care programme, after resolution of the particular periodontal
Optimal plaque control by the patient is of paramount importance for
a favourable clinical and microbiological response to any form of periodontal
Prof L P Samaranayake, Prof A Mombelli, Prof N Johnson
FDI Science Commission
FDI Science Commission Project 2-99: Indications and Contraindications
for Topical and Systemic Antibiotics in the Management of Periodontal
Disease Samaranayake LP and Johnson N Guidelines for the use of antimicrobial
agents to minimise the development of resistance FDI Commission Project
2-96. International Dental Journal 1999; 49: 189-195
Mombelli A and Samaranayake LP Topical and systemic antibiotics in the
management of periodontal diseases: FDI Commission Project 2-99, International
Dental Journal (in preparation)