zithromax and Gingival-Hyperplasia

It has been shown that azithromycin improves cyclosporine-induced gingival hyperplasia (GH), but its efficacy was never compared against an efficient oral hygiene program (OHP). The aim of this study was to analyze the effects of azithromycin plus OHP versus OHP alone in patients with cyclosporine-induced GH.. After periodontal evaluation, 20 renal transplant recipients received detailed oral hygiene instructions and a complete OHP, and were randomized to control (OHP) or azithromycin groups (OHP plus azithromycin). Patients were re-evaluated after 15 and 30 days. Both groups were similar in time after transplant, age, gender, cyclosporine dose, and cyclosporine through level and serum creatinine. The control group had fewer patients using calcium cannel blockers (10% vs. 70%, p = 0.02).. All patients improved in pain, halitosis, and gum bleeding after OHP. The control group did not improve plaque index (PI) or GH. In contrast, baseline PI decreased from 1.52 +/- 0.28 to 0.50 +/- 0.16 on day 15 (p < 0.01) and to 0.46 +/- 0.14 on day 30 (p < 0.01) in the azithromycin group, and the GH score decreased from 1.9 +/- 0.27 to 0.90 +/- 0.27 on day 15 (p < 0.05) and to 0.70 +/- 0.21 on day 30 (p < 0.01).. Azithromycin associated to efficient OHP induced a striking reduction in cyclosporine-induced GH, while efficient OHP alone improved oral symptoms but did not decrease cyclosporine-induced GH.

Topics: Adult; Analysis of Variance; Anti-Bacterial Agents; Azithromycin; Combined Modality Therapy; Cyclosporine; Female; Follow-Up Studies; Gingival Hyperplasia; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Oral Hygiene; Surveys and Questionnaires; Treatment Outcome

Gingival hyperplasia is a well-known complication of cyclosporine therapy, affecting 21% to 35% of renal transplant patients. Metronidazole, clarithromycin, and azithromycin, all azalid antimicrobial agents derived from the macrolide antibiotic erythromycin, have been used for treatment. Marked improvements in gingival hyperplasia have been recorded in particular with azithromycin. The aim of the present study was to investigate histopathological features of cyclosporine-induced gingival hyperplasia and to evaluate the quantitative efficacy of short-term azithromycin therapy.. Eighteen renal transplant patients with cyclosporine-induced gingival hyperplasia were included in the study. All patients received azithromycin with a dose of 500 mg/d for 3 consecutive days. Changes in gingival hyperplasia were evaluated by measuring the gingival sulcus depth to the cementum-enamel junction of every tooth in each of the four quadrants on days 0, 7, 30, 90, 180. Gum biopsies were obtained on days 0 and 30; the degree of inflammation was classified as "mild," "intermediate," and "severe".. Gingival hyperplasia was reduced in all treated patients throughout the study. The degree of improvement was more significant between 0 to 7 and 7 to 30 days than at other times (respectively, P < .0001 and P < .002). Histopathologically, eight patients had severe and one patient moderate chronic inflammation at the beginning of therapy. Three other biopsies were reported as papilloma, mucosal hyperplasia, and normal gingival tissue biopsy.. Azithromycin appears to be useful to treat cyclosporine-induced gingival hyperplasia in renal transplant patients. Treatment is inexpensive and free from known adverse effects.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Biopsy; Cyclosporine; Female; Gingival Hyperplasia; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Calcium Channel Blockers; Cyclosporine; Female; Follow-Up Studies; Gingival Hyperplasia; Humans; Hypertension; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Time Factors

Topics: Anti-Bacterial Agents; Area Under Curve; Azithromycin; Creatinine; Cyclosporine; Follow-Up Studies; Gingival Hyperplasia; Humans; Immunosuppressive Agents; Kidney Transplantation; Postoperative Complications; Recurrence; Time Factors; Treatment Outcome

Gingival hyperplasia (GH) is a common side effect of cyclosporine . Azithromycin (Zithromax; AZI) is a macrolide antibiotic reported in case studies to reduce cyclosporine-induced gingival hyperplasia (CIGH) in renal transplant recipients (RTR).. The efficacy of AZI to treat CIGH in RTR was examined in a double-blind, randomized crossover trial. Patients (n=17) with CIGH were randomized to receive AZI and a matching placebo in alternate order for 5 days, separated by a 2-week washout period. Follow-up visits were conducted at week 6 and week 12. Changes in GH were evaluated by measuring the clinical gingival sulcus depths, tooth length, and the length of the interdental papillae to the cementum-enamel junction of two teeth in each of the four quadrants.. Significant improvements were observed in all three types of periodontal measurements, representing reductions of gingival tissue above the medial aspect of the tooth, of the gingival sulcus depth, and of the length of the interdental papillae. Patients reported an improvement in gum bleeding. AZI was well tolerated, and 67% of the patients reported that the treatment was at least somewhat useful.. AZI should be considered for RTR with CIGH.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Cyclosporine; Double-Blind Method; Female; Gingival Hyperplasia; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Prospective Studies

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Cyclosporine; Female; Gingival Hyperplasia; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Longitudinal Studies; Male; Middle Aged; Patient Selection

Gingival hyperplasia is a known complication of cyclosporin therapy. Although plaque control has been shown to be of benefit, gingival surgery is occasionally necessary. The aim of this study was to review the effect of a short-course therapy with azithromycin in renal transplant patients with cyclosporin-induced gingival hyperplasia.. Thirty-eight patients received 500 mg/day of azithromycin for 3 consecutive days. The degree of gingival hyperplasia was classified as: 0, no gingival overgrowth; 1, mild overgrowth; 2, moderate overgrowth, and 3, severe overgrowth. Gingival bleeding and evolution of gingival hyperplasia were determined at 0 (pretreatment), 7, 30, 90 and 180 days. Cyclosporin, serum creatinine and ALT levels were simultaneously determined on the same days.. Seven patients were excluded, leaving a total of 31 included in the trial. Eleven had a score of 3, 17 a score of 2, and 3 a score of 1. The degree of gingival hyperplasia was unrelated to the dose and levels of cyclosporin. Gingival hyperplasia improved in all patients (P < 0.001, Friedman test). The degree of improvement was better when the degree of hyperplasia was lower. In 27 patients gingival hyperplasia remained absent 6 months later, 3 patients required a second course of treatment, and another required gingival surgery. Gingival bleeding, present in 28 patients when diagnosed, disappeared in all cases in 2.2 +/- 1.2 (1-7) days. No adverse effects were observed. Cyclosporin, serum creatinine, and ALT levels were not affected by treatment.. Azithromycin improves cyclosporin-associated gingival hyperplasia, especially when administered early in the process.

Topics: Adult; Aged; Anti-Bacterial Agents; Azithromycin; Cyclosporine; Female; Gingival Hyperplasia; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Postoperative Care

Management of drug-influenced gingival enlargement is challenging, and surgery is most often indicated. However, because of a unique mechanism of action, azithromycin helps in the management of gingival enlargement caused by cyclosporine. An incidental observation of the effect of azithromycin in the cyclosporine-influenced gingival enlargement by physicians in 1995 led to series of basic investigations and clinical trials confirming this observation and providing a non-surgical treatment modality.. In this report, successful management of cyclosporine-influenced gingival enlargement in a 39-year-old renal transplant patient with the use of azithromycin without any surgical intervention is presented.. Use of azithromycin for managing cyclosporine-influenced gingival enlargement is a useful alternative or adjunct to surgical management. It is hoped that this report will raise further awareness of this non-surgical modality in patients taking cyclosporine.

Topics: Adult; Azithromycin; Cyclosporine; Gingival Hyperplasia; Gingival Overgrowth; Humans; Immunosuppressive Agents

Topics: Adult; Allografts; Anti-Bacterial Agents; Azithromycin; Cyclosporine; Female; Gingival Hyperplasia; Gingivitis; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Immunosuppressive Agents; Lymphoma, T-Cell, Peripheral

Topics: Anti-Bacterial Agents; Azithromycin; Calcium Channel Blockers; Gingival Hyperplasia; Humans; Hypertension; Treatment Outcome

Anecdotal evidence suggests that azithromycin is effective for the treatment of cyclosporine-induced gingival hyperplasia in solid-organ transplant recipients. We present the cases of two heart transplant patients who insidiously developed gingival hyperplasia, likely because of immunosuppression with cyclosporine, which was treated with azithromycin. Evidence supporting the efficacy of azithromycin in the treatment of cyclosporine-induced gingival hyperplasia in solid organ transplant recipients was searched for, identified, and then critically assessed. While no data were found specifically evaluating azithromycin in cardiac transplant patients, there were nine pertinent papers identified that evaluated the clinical question of interest in the renal transplant population [Wahlstrom et al. (1995) The New England Journal of Medicine 332, 753; Boran et al. (1996) Transplantation Proceedings 28, 2316; Gomez et al. (1997) Nephrology Dialysis Transplantation 12, 2694; Ljutic (1997) Dialysis & Transplantation 26, 787; Puig et al. (1997) Transplantation Proceedings 29, 2379; Nash et al. (1998) Transplantation 65, 1611; Nowicki et al. (1998) Annals of Transplantation 3, 25; Wirnsberger et al. (1998) Transplantation Proceedings 30, 2117; Citterio et al. (2001) Transplantation Proceedings 33, 2134]. These studies and case reports are summarized. While more evidence is required to support routine use of azithromycin for the treatment of cyclosporine-induced gingival hyperplasia in cardiac transplant recipients, preliminary published evidence from renal transplant patients is certainly favourable.

Topics: Administration, Oral; Anti-Bacterial Agents; Azithromycin; Cyclosporine; Gingival Hyperplasia; Heart Transplantation; Humans; Immunosuppressive Agents; Male; Middle Aged

Topics: Anemia, Aplastic; Azithromycin; Cyclosporine; Female; Gingival Hyperplasia; Humans; Middle Aged; Tacrolimus

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Cells, Cultured; Female; Gingiva; Gingival Hyperplasia; Humans; Kidney Transplantation; Male; Middle Aged; Risk Factors

Topics: Anti-Bacterial Agents; Azithromycin; Cyclosporine; Female; Gingival Hyperplasia; Humans; Immunosuppressive Agents; Kidney Transplantation; Middle Aged

Gingival hyperplasia is a well recognised complication of cyclosporin A therapy. Although its pathogenesis is still debated in several recent reports a second generation macrolide antibiotic-azithromycin induced partial or even complete regression of hyperplasia. We present a patient after kidney transplantation treated with cyclosporin who developed very advanced gigival overgrowth (stage 3+). The patient received a 3-day treatment with azithromycin which was repeated after 3 months. The first course of the drug caused a partial regression of gingival hyperplasia during following months but the repeated treatment did not provide a further regression of the changes.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Cyclosporine; Female; Gingival Hyperplasia; Humans; Immunosuppressive Agents; Kidney Transplantation; Postoperative Complications

Topics: Anti-Bacterial Agents; Azithromycin; Cyclosporine; Gingival Hyperplasia; Graft Rejection; Humans; Kidney Transplantation

Topics: Adult; Anti-Bacterial Agents; Azathioprine; Azithromycin; Calcium Channel Blockers; Cyclosporine; Female; Gingival Hyperplasia; Humans; Hypertension; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Prednisolone

Topics: Adult; Azithromycin; Cyclosporine; Female; Gingival Hyperplasia; Humans; Male; Middle Aged