Local drug delivery of 0.5% azithromycin in the treatment of chronic periodontitis among smokers

Abstract

Background: Along with conventional periodontal surgical therapy, local delivery of antibiotics may provide more effective treatment in smokers by targeting tissue-invasive bacteria. The aim of this randomized, placebo-controlled, doublemasked clinical trial was to evaluate the adjunctive effects of subgingivally delivered 0.5% azithromycin (AZM) as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis in smokers. Methods: Fifty-four patients were randomized and categorized into two treatment groups: Group 1 -26 subjects who received (SRP) plus placebo gel and Group 2 -28 subjects who received (SRP) plus 0.5% azithromycin. Clinical parameters were recorded at baseline, 3, 6 and 9 months. They included Plaque Index (PI), modified Sulcus Bleeding Index (mSBI), probing depth (PD) and clinical attachment level (CAL). Results: Azithromycin resulted in significant improvements. A single application of AZM resulted in attachment gain at 9 months of 2.44 ± 0.64 mm as compared to 0.18 ± 0.68 mm for the placebo. Similarly, pocket depth and PI were significantly reduced but no change in the mSBI was noted. Conclusions: When compared to the placebo, the adjunctive use of 0.5% AZM resulted in significant improvement in clinical outcome in the treatment of chronic periodontitis among smokers.

Clinical effect of azithromycin as an adjunct to non‐surgical treatment of chronic periodontitis: a meta‐analysis of randomized controlled clinical trials

“…After full text reviews, we excluded two; one article lacked a concurrent controlled group and one article was not published as a full report . Finally, 14 articles were included in the meta‐analysis (Fig. S1).…”

Commentary: Targeting Underlying Biologic Mechanisms in Selecting Adjunctive Therapies to Improve Periodontal Treatment in Smokers: A Commentary

“…Meta‐analysis was performed as part of the systematic review, but none of the studies evaluated used the same antibiotic and/or delivery method. Among the studies that evaluated locally delivered antibiotics, no statistically significant clinical benefit was seen with local application of MET, 7 whereas the other three medications (clarithromycin [CLAR], doxycycline [DOX], and, AZT) did demonstrate improvement in clinical parameters 17 , 18 , 21 . It is interesting to note that macrolide antibiotics (e.g., CLAR and AZT) have been shown to accumulate in gingival fibroblasts, oral epithelial cells, and host immune cells at concentrations ≤38‐fold higher than extracellular levels 45–47 .…”

“…However, it is interesting to note that these authors considered in their review only systemic antimicrobials/antibiotics at bactericidal and/or bacteriostatic dosages, and adjunctive use of low‐dose systemically administered antibiotics was not examined 16 . Of six studies included in the present systematic review, 17–22 four include local delivery of antibiotics 17‐19,21 and two include systemic delivery of antibiotics 20 , 22 . Among patients who received scaling and root planing (SRP) and systemic antibiotics, 15 received a 5‐day course of azithromycin (AZT), 20 and 27 received a 10‐day course of metronidazole (MET) 22 .…”

A Comparative Evaluation of Systemic Azithromycin and Ornidazole - Ofloxacin Combination as an Adjunct to Scaling and Root Planing In the Treatment of Chronic Generalised Periodontitis

“…In a study by Oteo and Herrea [24], the adjunctive use of systemic azithromycin in the treatment of P gingivalis periodontitis demonstrated significant clinical and microbiological benefits when compared to SRP plus placebo. In a study by Pradeep et al [25], local drug delivery of 0.5% azithromycin in the treatment of chronic periodontitis among smokers was done. The study concluded that when compared to the placebo, the adjunctive use of 0.5% AZM resulted in significant improvement in clinical outcome in the treatment of chronic periodontitis among smokers.…”