Этиотропная терапия агрессивного пародонтита: современные схемы антибактериальной терапии и их эффективность
Abstract
Introduction. Aggressive periodontitis is a rapidly progressing periodontal disease characterized by swift destruction of the periodontal complex tissues with minimal clinical signs of inflammation. Despite the paucity of symptoms, the disease is accompanied by significant bone loss, which often leads to diagnostic challenges. Aim. To conduct a systematic analysis of contemporary antibiotic regimens for the treatment of aggressive periodontitis, evaluating their efficacy, pharmacological characteristics, and clinical advantages based on global literature data. Materials and Methods. A comprehensive search and critical analysis of scientific publications indexed in Scopus, Web of Science, and PubMed was performed. The study included publications focused on etiotropic therapy for patients with various forms of aggressive periodontitis, published between 2015 and 2025, with a minimum follow-up duration of six months. Experimental studies and case reports were excluded. In total, 55 publications were analyzed. Results and Discussion. It was found that in clinical practice, the most frequently used antibiotics for the treatment of aggressive periodontitis include macrolides (500 mg once daily for 3 days), fourth-generation fluoroquinolones (400 mg once daily for 7 days), as well as combination regimens comprising β-lactam antibiotics with nitroimidazoles, with dosage and course duration varying across studies. The preference for macrolides and fluoroquinolones is primarily based on their favorable pharmacokinetic properties, particularly their ability to penetrate deeply into inflamed tissues and accumulate within innate immune effector cells. Combination of amoxicillin and metronidazole demonstrates a pronounced synergistic effect, including suppression of matrix metalloproteinase production and broad-spectrum antibacterial coverage encompassing both aerobic and anaerobic pathogens. Interregional variations observed in microbial composition underscore the necessity of personalized etiotropic therapy tailored to local microbial profiles and pathogen susceptibility. Conclusions. Despite extensive research into the etiotropic management of aggressive periodontitis and endorsement of the antibacterial approach by leading professional associations, a standardized treatment protocol has not yet been established. The synthesized evidence emphasizes the importance of individualized antibiotic therapy, taking into account the microbial spectrum, clinical course, and pathogen sensitivity. Future research prospects involve enlarging sample sizes and conducting comparative analyses of different antibiotic regimens to enhance the efficacy of aggressive periodontitis management