Comparing antibiotic adjuncts in periodontitis

We were concerned to read that the paper in the March 2019 Issue of the Australian Dental Journal by Liaw et al.1 made no reference to the need for all health professionals, including dentists, to be proactive in antibiotic stewardship. We are well into the post antibiotic age brought on by squandering the life saving benefits of antibiotics on non-bacterial or trivial uses. This is particularly so for azithromycin which is a macrolide antibiotic invaluable in some life-threatening respiratory infections in immunocompromised, HIV and oncology patients. It is also invaluable in complex sexually transmitted diseases and there is already a rising rate of azithromycin resistant chlamydia. It is not recommended where other more common antibiotics are indicated.2 On examination of this pilot study it is stated that antibiotics ‘might’ have an adjunctive role in managing periodontitis. Surely the only ethical conclusion for this study, when all the facts taken into account, is that there is no place for antibiotics in the management of chronic periodontitis, which can be demonstrably managed by appropriate local dental treatment.