Azithromycin in Periodontal Therapy: Beyond the Antibiotics

Abstract

Periodontitis is a multifactorial disease, in which microorganisms in plaque biofilm play a major role. Scaling and root planing is the primary mode of non-surgical treatment for periodontal disease. Adjunctive use of an antimicrobial is advocated in certain periodontal disease conditions. Azithromycin might be considered a promising adjunctive drug in the treatment for periodontal disease because of its distinguished characteristic of immunomodulation, anti-inflammatory and antibiotic property along with the accumulation in higher concentration into the acute reactant cells and sustained release at the site of infection. This antibiotic is popular for its very simple dosage regime and limited side effects. The objective of this literature review to highlight the mechanism and potential favourable role in the management of various form of the periodontal disease.

Assessment of Resistin Level Using Azithromycin as an Adjunctive to Non-Surgical Treatment of Periodontitis Patients with Type II Diabetes Mellitus

“…These results could be explained by the fact that SDD could enhance the results of a number of mechanical nonsurgical interventions by inhibition of MMPs which is involved in periodontal tissue destruction (31) . In addition to the effect of azithromycin is due to highly uptake by fibroblasts and acute reactant cells, such as neutrophils, macrophages, monocytes, and lymphocytes which is increased in inflamed tissues (32) . AZM has been shown to decrease proinflammatory cytokine expression such as IL-1β, IL-6, IL-8 and TNF-alpha, growth factors such as granulocyte-macrophage colony-stimulating factor, and also increase the amount of alveolar macrophages actively phagocytosing (33) .…”

Antibiotic Therapy in Dentistry

“…Azithromycin is a bacteriostatic antibiotic that has a great potency against Gram-negative pathogens and is considered to be the safest among the macrolides [ 56 , 63 ]. The drug is not suggested as the first-line treatment of odontogenic infections and is usually prescribed as an alternative in penicillin-allergic patients [ 63 , 64 ].…”

“…The dosage of the drug is 500 mg once a day for three days, in case of therapeutic prescription, and 500 mg 1 hour before the oral procedure, in case of prophylactic administration [ 13 , 46 ]. The common side effects of azithromycin include nausea, diarrhea, and gastrointestinal disorders, and it should not be prescribed in erythromycin-allergic patients [ 21 , 56 , 63 ].…”

Comparison of Clinical Attachment Level Gain Using Scaling Root Planing Versus Adjunctive Azithromycin on Chronic Periodontitis

“…14 Azithromycin a macrolide antibiotic, has less resistance, fewer adverse effects, and is administered once daily which promotes patient compliance. 15 It accumulates effectively in phagocytes and has good periodontal tissue penetration thus being delivered in high concentrations to sites of infection where it remains detectable for 14 days. 15 Azithromycin has additional therapeutic benefit through its immunomodulatory effect.…”

“…15 It accumulates effectively in phagocytes and has good periodontal tissue penetration thus being delivered in high concentrations to sites of infection where it remains detectable for 14 days. 15 Azithromycin has additional therapeutic benefit through its immunomodulatory effect. 15 adjunctive use of azithromycin in a single dose of 500mg over three days has shown significant gain in CAL of chronic periodontitis patients.…”