Rethinking systemic adjuncts in periodontitis: a single centre acquisition cost comparison of antimicrobial and non-antimicrobial therapies

Aims To compare National Health Service (NHS) acquisition costs of systemic antimicrobial regimens with emerging non-antimicrobial adjuncts in periodontal therapy and to model potential national financial implications.Methods A secondary acquisition cost comparison analysis was undertaken using three-year prescription data (2021-2024) from a service evaluation at Charles Clifford Dental Hospital. Antibiotic prescriptions were cross-referenced with clinical records to identify those issued for periodontitis. Direct acquisition costs were calculated using Sheffield Teaching Hospitals NHS Foundation Trust pricing.Results Of 643 antibiotic prescriptions, 445 (69.2%) were issued for periodontitis. Azithromycin accounted for 93.5% of periodontal prescriptions, whereas guideline-recommended amoxicillin plus metronidazole (A+M) represented 1.6%. Compared with A+M (£2.81 per course), azithromycin reduced acquisition costs by 55.16%. Non-antimicrobial adjuncts demonstrated substantially greater reductions depending on treatment duration, with metformin 500 mg achieving up to 91.46% reduction.Conclusions Non-antimicrobial systemic adjuncts demonstrate considerable direct cost advantages over traditional antimicrobial regimens. These findings highlight potential economic and antimicrobial stewardship benefits and support the need for formal cost-effectiveness analyses to inform future prescribing guidance.