patients who had received systemic antibiotics adjunctively showed better results regarding probing pocket depth, clinical attachment level, gingival bleeding index and radiological bone fill.As it seems, from the above-mentioned studies, that adjunctive systemic antibiotics improve the clinical outcome in patients with localized aggressive periodontitis, the question arises of whether the type of antibiotic is of importance. This aspect was addressed by Akincibay et al. (2), who compared the clinical outcome of systemic doxycycline vs. systemic metronidazole combined with amoxicillin during scaling and root planing. They randomly divided 30 patients into two treatment groups. The fi rst group received 100 mg of doxycycline for 10 days and the second group received 375 mg of amoxicillin and 250 mg of metronidazole three times a day for 10 days. They found that both groups showed signifi cant improvements in plaque index, gingivitis index, periodontal probing depth and clinical attachment level values.The metronidazole plus amoxicillin group showed significantly more improvement in plaque index and gingivitis index. Although the authors reported no statistically signifi cant differences in probing pocketdepths and attachment levels between both groups at the end of the study, there was at least a clear tendency for more improvement in the metronidazole plus amoxicillin group.In contrast to localized aggressive periodontitis, the effect of systemic antibiotics as an adjunct to scaling and root planing in generalized aggressive periodontitis has been subjected to many more randomized,placebo-controlled studies. Among a variety of antibiotics that can be used and have been tested as adjuncts in generalized aggressive periodontitis, the combination of amoxicillin and metronidazole is becoming advocated to an increasing extent. The rationale behind combining both antibiotics has found its origin in the observation that A. actinomycetemcomitans was resistant to tetracycline, the antibiotic of choice in the 1990s (83, 105). The failure of tetracycline to suppress A. actinomycetemcomitans, together with in-vitro data showing the synergistic effect of metronidazole and
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