"Comparison of Systemic Ciprofloxacin in Elimination of A.a from Active Sites with Combination of Metronidzole and Amoxicillin in Patients with Aggressive Periodontitis: A Randomized Double Blind Controlled Trial "

Abstract

Statement of Problem: The elimination of Actinobacillus actinomycetemcomitans (A.a) is a key factor for achieving a successful treatment in patients with aggressive periodontitis (AgP) whom harboring this organism. This micro organism’s capability to invade to host’s tissues, makes its eradication with mechanical therapy (eg. flap surgery, scaling, oral hygiene) very difficult, so there is no other way than using a systemic antibiotic. But which antibiotic is the best one? The Ciprofloxacin is the only antibiotic which can suppress all strains of A.a. Purpose: The aim of this study was to compare the effectiveness of Ciprofloxacin in elimination of A.a in active sites of AgP patients with combination of Metronidazole and Amoxicillin. Materials and Methods: This study was a randomized double blind controlled clinical trial. Twenty four patients with clinical diagnosis of AgP and detection of A.a in their pockets were randomly divided into two groups. The 12 patients in test group received Ciprofloxacin (10 days BID 1gr) plus the placebo capsules representing Metronidazole and Amoxicillin. The other 12 patients named control group, received Metronidazole (7 days TID 750mg) plus Amoxicillin (7 days TID 1.5gr) and the placebo tablet representing Ciprofloxacin. Neither the patients nor the doctors knows the grouping sequences. Bacteria Culturing and measurement of Gingival Index (GI) and plaque Index (PI) were done at the baseline and repeated about 10 days after prescribing the medicines. T- test and chi-square test were used for Statistical analysis. Results: There was no difference between two groups in the A.a Positives sites, GI scores and PI scores at the baseline. Ciprofloxacin eliminates A.a from 91.7% of sites and Metronidazole plus Amoxicillin eliminate A.a from 81.3% of sites. There was no significant difference between the test and control groups. The mean PI score for test and control groups were 1.39±0.66 and 1.39±0.88 respectively at the baseline and these values were 1.27±0.6 and 1.43±0.81 after receiving the designed medicine. There were no differences inter and intra groups at any time (P>0.05). Conclusion: Ciprofloxacin is as effective as Metronidazole plus Amoxicillin in elimination of A.a from active sites in AgP patients. Their longitudinal effects on clinical parameters such as probing depth, clinical attachment level, bleeding on probing and microbial flora need to be investigated.