A Systematic Review Evaluating Systemic Antibiotic Use and Resistance in Chronic Periodontitis: A Comprehensive Systematic Review

Abstract

Chronic periodontitis is a prevalent, multifactorial inflammatory condition that results in the progressive destruction of the supporting structures of the teeth. While conventional mechanical debridement remains the cornerstone of periodontal therapy, adjunctive use of systemic antibiotics has gained prominence, particularly in cases of aggressive disease, poor response to scaling and root planning (SRP), or compromised host immunity. However, the empirical use of antibiotics poses significant risks, notably the emergence of antimicrobial resistance (AMR), which threatens the long-term efficacy of periodontal therapies. This systematic review aims to evaluate the rationale, efficacy, and patterns of systemic antibiotic use in the treatment of chronic periodontitis, with a focus on the development of resistance among key periodontal pathogens. A comprehensive literature search was conducted according to PRISMA guidelines, identifying eligible studies published between January 2010 and March 2025. Clinical and microbiological outcomes, antibiotic resistance mechanisms, and evidence-based recommendations were synthesized. The findings underscore the importance of judicious antibiotic prescribing and highlight the need for targeted antimicrobial regimens based on microbiological diagnostics and susceptibility profiles.