Metronidazole may display anti‐inflammatory features in periodontitis treatment: A scoping review

Abstract Aim Metronidazole (MTZ) is an antimicrobial agent used to treat anaerobic infections. It has been hypothesized that MTZ may also have anti‐inflammatory properties, but the evidence is limited and has not been previously reviewed. Thus, this scoping review aimed to answer the following question: “What is the evidence supporting anti‐inflammatory properties of metronidazole that are not mediated by its antimicrobial effects?” Methods A scoping review was conducted according to the PRISMA‐ScR statement. Five databases were searched up to January 2023 for studies evaluating the anti‐inflammatory properties of MTZ used as monotherapy for treating infectious and inflammatory diseases. Results A total of 719 records were identified, and 27 studies (21 in vivo and 6 in vitro) were included. The studies reported experimental evidence of MTZ anti‐inflammatory effects on (1) innate immunity (barrier permeability, leukocyte adhesion, immune cell populations), (2) acquired immunity (lymphocyte proliferation, T‐cell function, cytokine profile), and (3) wound healing/resolution of inflammation. Conclusion Taken together, this scoping review supported a potential anti‐inflammatory effect of MTZ in periodontitis treatment. We recommend that future clinical studies should be conducted to evaluate specific MTZ anti‐inflammatory pathways in the treatment of periodontitis.