Influence of adjunctive azithromycin on microbiological and clinical outcomes in periodontitis patients: 6-month results of randomized controlled clinical trial

Abstract

Background: Our aim was to determine if azithromycin therapy, as an adjunct to scaling and root planing (SRP), decreases the number of pathobiontic subgingival plaque species and sites demonstrating pocket depth (PD) ≥ 5 mm and bleeding on probing (BOP) 6 months post-treatment. Methods: In a double-blind randomized parallel-arm placebo-controlled trial, 40 patients received nonsurgical periodontal treatment in two sessions within 7 days. Patients then received systemic antibiotic therapy (n = 20, azithromycin 500 mg/day for 3 days) or placebo (n = 20). Pooled microbiologic samples were taken before and 6 months after therapy and analysed by established culture methods. The primary outcome variable was the number of sites with PD ≥ 5 mm and BOP at the 6-month re-evaluation. Using multivariate multilevel logistic regression, the effects of gender, age, antibiotic therapy, presence of P. gingivalis or A. actinomycetemcomitans, smoking, tooth being a molar and interdental location were evaluated. Results: The number of sites with PD ≥ 5 mm and BOP after 6 months was similar in the test (Me = 4, IQR = 0-11) and control (Me = 5, IQR = 1-22) group. Adjunctive azithromycin treatment, compared to SRP alone, resulted in more frequent eradication of A. actinomycetemcomitans (p = 0.013) and C. rectus (p = 0.029), decreased proportion (p = 0.006) and total counts (p = 0.003) of P. gingivalis, and decreased proportion of C. rectus (p = 0.012). Both groups showed substantial but equivalent improvements in periodontal parameters, with no intergroups differences at initially shallow or deep sites. The logistic regression showed a lower odds ratio for healing of diseased sites on molars (OR = 0.51; p < 0,001). Conclusion: Despite significant changes in numbers of A. actinomycetemcomitans, P. gingivalis and C. rectus, patients with periodontitis do not benefit from adjunctive systemic azithromycin in terms of number of persisting sites with PD ≥ 5 mm and BOP.

Different scaling and root planing strategies in Turkish patients with aggressive periodontitis: A randomized controlled clinical trial

“…In this study, percentage of residual pockets significantly decreased at 3 months compared with baseline in all treatment strategies and maintained at 6 months. These findings were in accordance with previous studies 23,24,26,60 . Furthermore, the percentage of residual pockets was significantly lower after FMD than FM‐SRP or Q‐SRP at 3 months, but only Q‐SRP at 6 months.…”

“…These findings were in accordance with previous studies. 23,24,26,60 Furthermore, the percentage of residual pockets was significantly lower after FMD than FM-SRP or Q-SRP at 3 months, but only Q-SRP at 6 months. To date, there are no other studies available to enable comparisons between the re- Periodontal disease activity is regulated by complex interactions between the host immune system and periodontal pathogens.…”

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

“…The results of current study showed that by comparing clinical parameters demonstrated that there was an improvement in all clinical parameters (PD, GI, PI and CAL) in all groups with no significant difference between groups after a period of 3 months from NSPT. These results was in agreement with several studies that showed either NSPT alone or in conjunction with adjunctive therapy could improve the clinical outcomes with controlled TⅡDM periodontitis patients (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) .Group III who received azithromycin showed the highest improvement in GI. 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) .…”

Systemic Antibiotics as an Adjunct to Subgingival Debridement: A Network Meta-Analysis

“…These studies were conducted in Asia [ 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ], South America [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ], Europe [ 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 ], and Australia [ 81 , 82 ]. They were mostly single-centered [ 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ...…”