Using antibiotics as well as cleaning by a dental care profe | Figure 1

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Using antibiotics as well as cleaning by a dental care professional to treat gum disease

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What are the benefits and risks of using antibiotics as well as cleaning by a dental care professional to treat gum disease?

Why is this question important?

Gum disease is a common condition in which the gums become swollen, sore or infected. It is caused by bacteria that accumulate on gums and teeth. Diseased gums may bleed when people brush their teeth, and may cause bad breath. If gum disease is not treated, teeth can become loose and eventually fall out. This can affect a person’s ability to chew and speak. It can also make people feel self‐conscious about their appearance.

Dental‐care professionals can clean teeth and gums to remove excess bacteria from the mouth. They use special instruments – typically, an ultrasound scraper followed by specialised hand‐held instruments – to scrape bacteria from the teeth, and stop these from affecting the gums.

Antibiotics (medicines that kill bacteria) taken by mouth (orally) can be used alongside professional cleaning, to remove bacteria from the area between the teeth and gums. However, there are potential risks associated with antibiotics, such as allergic reactions and antibiotic resistance (changes in bacteria after exposure to antibiotics, that allow the bacteria to survive future antibiotic treatment).

We conducted a review of the evidence from research studies to find out about the benefits and risks of using antibiotics alongside professional dental cleaning to treat gum disease. We also wanted to know if some antibiotics work better than others in this situation.

How did we identify and evaluate the evidence?

First, we searched for randomized controlled studies (clinical studies where people are randomly put into one of two or more treatment groups), because these studies provide the most robust evidence about the effects of a treatment. We then compared the results, and summarized the evidence from all the studies. Finally, we rated our confidence in the evidence, based on factors such as study methods and sizes, and the consistency of findings across studies.

What did we find?

We found 45 studies that involved a total of 2664 people over the age of 18 who had gum disease. The studies compared professional cleaning plus antibiotics against professional cleaning alone, or compared different antibiotics used alongside professional cleaning against one another.

We cannot tell whether antibiotics reduce gum disease in the long term (one year or more after treatment), or whether some antibiotics are better than others. This is because we have very little confidence in the evidence we found.

We cannot tell whether antibiotics are associated with unwanted effects, because we have too little confidence in the evidence. The most commonly reported unwanted effects were temporary, mild gastrointestinal disturbances, such as nausea, vomiting, diarrhoea, or a metallic taste in the mouth. No serious unwanted effects were reported.

No studies reported on antimicrobial resistance or changes in people’s quality of life.

What does this mean?

We do not know whether:

‐ using antibiotics alongside professional cleaning is beneficial for treating gum disease in the long term (more than one year after treatment);

‐ using antibiotics alongside professional cleaning is associated with unwanted effects; or

‐ some antibiotics are better than others for treating gum disease alongside professional cleaning.

Our confidence in the available evidence is very low. The results of our review are likely to change if more evidence becomes available. Future studies should clearly define what qualifies as a minimally important improvement in gum disease.

How‐up‐to date is this review?

The evidence in this Cochrane Review is current to March 2020.

Read the full Cochrane Review

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\ \ Benefits and risks of antibiotics taken orally or given as an injection to treat chronic suppurative otitis media (persistent or recurring ear infection with discharge)\ Why is this question important?\ Chronic suppurative otitis media (CSOM), also known as chronic otitis media (COM), is an inflammation and infection of the middle ear that lasts for two weeks or more. People with CSOM usually experience recurrent or persistent discharge – fluid that leaks out from a hole or tear in the eardrum – and hearing loss.\ CSOM can be treated with antibiotics (medicines that fight bacterial infections) taken orally or given as an injection (i.e. systemic treatment in which the whole body is treated). Systemic antibiotics can be used:\ ‐ alone;\ ‐ in combination with antibiotics in the form of drops, sprays, ointments or creams (topical, i.e. localised surface treatment); or\ ‐ in combination with other treatments such as steroids (anti‐inflammation medicines) or antiseptics (substances that stop or slow down the growth of micro‐organisms).\ To find out how effective systemic antibiotics are for treating CSOM, and whether they lead to side effects, we reviewed the evidence from research studies.\ How did we identify and evaluate the evidence?\ First, we searched the medical literature for studies that followed people with CSOM for at least one week and compared:\ ‐ a systemic antibiotic used alone against a placebo (dummy) treatment, no treatment or another systemic antibiotic;\ ‐ a systemic antibiotic combined with another treatment, against that treatment alone.\ We then compared the results, and summarised the evidence from all the studies. Finally, we rated our confidence in the evidence, based on factors such as study methods and sizes, and the consistency of findings across studies.\ What did we find?\ We found 18 studies that involved a total of 2135 people with CSOM. People were treated for between five days and 12 weeks, and were followed for up to one year. Four studies provided information about how they were funded or who supplied the medicines: two were publicly funded, and medicines were provided by pharmaceutical companies in the other two studies.\ Studies compared:\ ‐ systemic antibiotics against no treatment (one study);\ ‐ systemic antibiotics plus topical antibiotics against topical antibiotics alone (six studies);\ ‐ systemic antibiotics plus other treatments (other than topical antibiotics alone), against these same treatments without systemic antibiotics (four studies);\ ‐ different systemic antibiotics against one another (eight studies).\ Systemic antibiotics alone against no treatment\ We cannot determine from the only study we found whether systemic antibiotics alone are better or worse than no treatment. This is mainly because the study:\ ‐ was small;\ ‐ was conducted in ways that could have introduced error in the results; and\ ‐ reported limited information.\ Systemic antibiotics plus topical antibiotics against topical antibiotics alone\ Systemic antibiotics plus topical antibiotics may have little to no effect on whether discharge stops after one to two weeks, compared against topical antibiotics alone (five studies). We do not know if systemic antibiotics added to topical antibiotics have any other positive or negative effects, because:\ ‐ there are too few studies;\ ‐ available studies were small and may have been conducted in ways that introduce error in their results.\ Systemic antibiotics plus other treatments (other than topical antibiotics alone), against these same treatments without systemic antibiotics\ We cannot determine from the evidence available whether systemic antibiotics are effective or lead to adverse events when added to treatments other than topical antibiotics only. This is mainly because the few studies available reported limited information.\ Comparisons between different systemic antibiotics\ We do not know whether some systemic antibiotics are better than others. This is mainly because the way studies were conducted is likely to have introduced error in their results.\ What does this mean?\ There is insufficient robust evidence to determine whether systemic antibiotics are effective treatments for CSOM, and whether they lead to side effects. Evidence about side effects is particularly limited. When added to topical antibiotics, systemic antibiotics may make little to no difference to whether discharge resolves after one to two weeks. We do not know if some systemic antibiotics are better than others.\ How‐up‐to date is this review?\ The evidence in this Cochrane Review is current to March 2020.](https://app.figure1.com/case-detail/2a9fc52f-5f63-4054-bbac-2f00bea18998)

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\ \ Is chloroquine or hydroxychloroquine useful in treating people with COVID‐19, or in preventing infection in people who have been exposed to the virus?\ What is the aim of this review?\ COVID‐19 is an infectious respiratory disease caused by a coronavirus called SARS‐CoV‐2. If the infection becomes severe, people may need intensive care and support in hospital, including mechanical ventilation.\ Drugs used for other diseases were tried out in COVID‐19, and this included chloroquine, used for malaria; and hydroxychloroquine used for rheumatic diseases, such as rheumatoid arthritis or systemic lupus erythematosus. 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