zithromax and Gingival-Overgrowth

The aim of this systematic review was to evaluate studies that analyzed the effect of systemically administered azithromycin (AZM) on cyclosporine A (CsA)-mediated gingival overgrowth (GO).. A systematic literature search was performed for publications published by January 1, 2019, using electronic databases and hand search. Human clinical trials (>10 patients) with systemic administration of AZM and a follow-up of ≥6 months, published in the English or German language, were included.. From 266 titles identified, 6 publications with data from 104 patients were included. A great heterogeneity in terms of sample size, administration/dosage regimen of AZM, consideration of potential confounders and measurement of GO was observed. Treatment duration with AZM ranged from 3 to 5 days with a maximum dosage of 500 mg/day, gingival response was measured by using various scoring systems. A synthesis of results, by using a vote counting method, was applied. In all included studies, a beneficial effect of systemically administered AZM with respect to a reduction of GO was documented.. Limited evidence from 6 case series suggests a positive effect of systemically administered AZM on the reduction of CsA-mediated GO. Azithromycin may be considered a potential alternative to surgical reduction of GO.

Topics: Anti-Bacterial Agents; Azithromycin; Cyclosporine; Gingiva; Gingival Overgrowth; Humans; Immunosuppressive Agents

Azithromycin is a macrolide antibiotic used extensively in medicine for the treatment of a wide range of infections such as upper respiratory tract infections, middle ear infections, sexually transmitted infections and trachoma. It is also effective against the most common periodontopathogens. The versatility of the macrolides extends beyond their antibiotic properties as a result of their well-documented immune-modulating/anti-inflammatory effects. Macrolides, including azithromycin, are therefore used to treat diseases not associated with bacteria, such as severe asthma, chronic obstructive pulmonary diseases and, more recently, cystic fibrosis. Azithromycin is concentrated in neutrophils, macrophages and particularly fibroblasts; all of these cells are central players in the pathogenesis of most periodontal diseases. This paper reviews the diverse properties of azithromycin and the clinical periodontal studies of its effects in both the treatment of periodontitis and in resolving drug-related gingival overgrowth. Evidence exists to support the use of a single course of azithromycin in the treatment of advanced periodontal diseases. Azithromycin could have a triple role in the treatment and resolution of periodontal diseases: suppressing periodontopathogens, anti-inflammatory activity and healing through persistence at low levels in macrophages and fibroblasts in periodontal tissues, even after a single course of three tablets. If future periodontal research confirms these properties, it could become a valuable host-modulator in periodontal treatment.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Azithromycin; Fibroblasts; Gingival Overgrowth; Humans; Immunologic Factors; Macrophages; Periodontal Diseases; Periodontitis

This study aimed to evaluate the effect of azithromycin (AZM) on the inflammatory and fibroblastic part of cyclosporine A (CsA)-induced gingival overgrowth (GO) in renal transplanted patients.. In this randomized clinical trial, subjects with GO receiving CsA were randomly divided into two groups: those receiving 5-day AZM only (n = 12; group 1) and those receiving scaling and prescribed AZM after 2 months (n = 12; group 2). Both groups were evaluated for several indices (gingival hyperplastic index, plaque and bleeding index, clinical crown length) at the first visit and the 4th and 8th week in group 1, and at the first visit and the 4th, 8th, 12th, and 16th week in group 2.. The sample included 24 individuals. The mean (SD) age of participants was 30.81 (11.13) and 34.80 (9.33) years in group 1 and 2, respectively. Based on ANCOVA, the changes in the hyperplastic index (GHI) and apico-coronal dimension (ACD) of it were statistically significant in professional scaling accompanied by AZM group (P = 0.012 and 0.031, respectively). However, no significant change was observed in mean indices after prescribing AZM in 5-day AZM regimen group (P = 0.664 and 0.882, respectively). According to one-way ANOVA, we found a statistically significant correlation in GHI, ACD, bleeding index (BI), and plaque index (PI) accounting for P = 0.012, 0.003, 0.002, and <0.001, respectively.. Findings suggest that AZM cannot influence the fibroblastic part of GO in presence of gum inflammation while the therapy can improve GO after resolving it with scaling.

Topics: Azithromycin; Cyclosporine; Gingival Overgrowth; Humans; Immunosuppressive Agents; Kidney Transplantation

Gingival overgrowth is an adverse effect of ciclosporin therapy. Azithromycin (AZI) in capsule and toothpaste form is an effective treatment for ciclosporin-associated gingival overgrowth (CsAGO) in humans.. To evaluate AZI in a systemic and a toothpaste form for the treatment of CsAGO in dogs. The secondary objective was to determine which treatment is more effective.. Thirty-six client-owned dogs with CsAGO.. Dogs were randomly assigned to the following four groups: AZI capsule; AZI toothpaste; placebo capsule; and placebo toothpaste. Treatments were for 4 weeks, and measurements of gingival sulcus depth, tooth length and subjective global scores were taken at weeks 0, 2, 4 and 8. The AZI dose was 10 mg/kg daily, and brushing (8.5% AZI) was once daily.. There was a significant decrease in gingival sulcus depth for the AZI capsule group at week 8 and for the AZI toothpaste group at weeks 2, 4 and 8. The mean decrease in gingival sulcus depth was significantly greater in active versus placebo groups (P = 0.0356). The tooth length and subjective global scores were not significantly different for any groups. Gastrointestinal adverse events occurred in all groups, but more frequently in the AZI capsule group.. Azithromycin improved CsAGO in only one measured parameter, gingival sulcus depth. Only one dog in the AZI capsule group had complete resolution of CsAGO. Further studies are warranted. Azithromycin capsules were associated with the most gastrointestinal adverse effects.

Topics: Administration, Oral; Administration, Topical; Animals; Anti-Bacterial Agents; Azithromycin; Cyclosporine; Dog Diseases; Dogs; Dosage Forms; Female; Gingival Overgrowth; Immunosuppressive Agents; Male

Gingival overgrowth is a complication of cyclosporine therapy following organ transplantation. Oral azithromycin is frequently used to treat this complication. This study examined the efficacy of local azithromycin, in the form of toothpaste, against cyclosporine-induced gingival overgrowth.. Twenty stable renal transplanted patients (10 men and 10 women) with gingival hyperplasia were randomly assigned to a test group and a control group. Azithromycincontaining toothpaste had 85 mg azithromycin per gram of toothpaste. Both toothpastes were prescribed b.i.d., each time using 1.5 cm, for 1 month. All participants received scaling, root planing, polishing, and oral hygiene instructions, at least 4 weeks prior to initiation of the study. Gingival overgrowth index, bleeding on probing, blood urea nitrogen, creatinine, and serum cyclosporine levels were measured at baseline, and then again in the second and fourth weeks after tooth brushing. Patient satisfaction with the toothpastes was evaluated by a visual analogue scale. The stability of clinical responses was followed for 3 months after cessation of the toothpastes.. Gingival overgrowth index decreased significantly in the azithromycin-containing toothpaste group (from 1.1+/-0.56 to 0.51+/-0.47, P<.001); however, in the control group, this decrease was not significant (P=.22). Bleeding on probing also decreased significantly in patients in the azithromycin-containing toothpaste group compared with controls (P=.001). When compared with baseline levels, trough levels of cyclosporine, blood urea nitrogen, and creatinine did not change in either of the groups. Patients in the control group were more satisfied with the toothpaste than were patients in the test group (53 vs 38).. Azithromycin-containing toothpaste is an effective, simple, and noninvasive treatment for cyclosporine-induced gingival overgrowth.

Topics: Adult; Azithromycin; Cyclosporine; Female; Gingival Overgrowth; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Toothpastes

Gingival overgrowth usually characterized by increased cellular growth of gingival fibroblasts appears to be multifactorial. In patients receiving CyA for more than 3 months, the incidence can approach 70% and can be attributed to pharmaceutical immunosuppression. Case reports have reported regression of overgrowth with both metronidazole and azithromycin. The goal of this study was to determine the efficacy of metronidazole and azithromycin in reducing CyA-induced gingival overgrowth. Twenty-five patients were included in this double-blinded randomized study. All patients were receiving CyA as medically indicated and diagnosed with gingival overgrowth by a dentist. Patients were randomized to receive either 5-days of azithromycin or 7-days of metronidazole given at baseline only. The extent of gingival overgrowth was measured at 0, 2, 4, 6, 12, and 24 wk. Fourteen patients at CCF and 11 patients at CCHMC were studied. Repeated measures anova was performed to assess differences within and between groups. Gingival overgrowth at baseline was not statistically different between groups. The mean degree of gingival overgrowth after treatment was different across all time intervals (p = 0.0049) showing azithromycin to be more effective than metronidazole. Therapy with azithromycin offers an effective alternative to the management of CyA-induced gingival overgrowth.

Topics: Adolescent; Adult; Analysis of Variance; Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Child; Child, Preschool; Cyclosporine; Double-Blind Method; Female; Gingival Overgrowth; Humans; Immunosuppressive Agents; Male; Metronidazole; Treatment Outcome

Drug-induced gingival overgrowth (GO) remains a challenge in periodontics. Partial and total regressions of this GO have been reported after a short course of antibiotics.. We conducted a double-blinded controlled randomised study to determine the effect of metronidazole (MNZ) or azithromycin (AZM) on the regression of incipient cyclosporin A-induced GO in 40 adult renal transplanted patients. The quantitation of the GO was performed with Image Digital Analysis.. None of the patients with GO showed complete remission after 30 days. The pretreatment GO index was 0.895 +/- 0.16 in the metronidazole treatment group (MNZ group, n = 13), 0.932 +/- 0.11 in the azithromycin treatment group (AZM group, n = 14), and 1.073 +/- 0.32 in the controls (placebo group, n = 13). At the end of the study (30 days), the GO index score was lower in 54.4% and 62.3% of the MNZ and AZM groups, respectively, and the mean score differences were statistically significant between the groups (0.897 +/- 0.28, MNZ group vs. 0.909 +/- 0.15, AZM group vs. 1.130 +/- 0.3, placebo group, P < 0.05 ANOVA).. A 7-day course of MNZ or AZM does not induce remission of CsA-induced GO, although it acts on concomitant bacterial over-infection and gingival inflammation.

Topics: Adult; Analysis of Variance; Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Cyclosporine; Dental Plaque Index; Double-Blind Method; Female; Follow-Up Studies; Gingival Overgrowth; Humans; Image Processing, Computer-Assisted; Immunosuppressive Agents; Kidney Transplantation; Male; Metronidazole; Middle Aged; Periodontal Index; Placebos; Remission Induction; Statistics, Nonparametric

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

Azithromycin, first synthesized in 1980, is a macrolide antibiotic related to erythromycin. It is widely used by the medical profession as a broad-spectrum antibiotic in the treatment of pneumonia, urinary tract infections and tonsillitis. In addition to its antibiotic properties, azithromycin has immune-modulating effects and is used for this reason in the management of cystic fibrosis and chronic obstructive pulmonary diseases. The drug is taken up by neutrophils, macrophages and fibroblasts, and is slowly released by these cells. Three diverse case reports are presented in which a single course of azithromycin (consisting of one 500 mg tablet being taken a day for three days) was prescribed before any periodontal intervention occurred. Azithromycin was the principal mode of treatment of severe chronic and aggressive periodontitis in Cases 1 and 2. Azithromycin, together with monthly subgingival debridement, was the treatment in Case 3 (severe chronic periodontitis in a poorly controlled diabetic complicated by gingival overgrowth related to medication with a calcium channel blocker). Favourable resolution of inflammation, reduction in pocket depths and evidence of bone regeneration were evident, even when no periodontal treatment had occurred. In Case 3, resolution of gingival overgrowth occurred over eight months. The potential implications for periodontal management, understanding of the pathogenesis of periodontal diseases and periodontal research are briefly discussed.

Topics: Adult; Aged; Aggressive Periodontitis; Alveolar Bone Loss; Anti-Bacterial Agents; Azithromycin; Bone Regeneration; Chronic Periodontitis; Combined Modality Therapy; Diabetes Mellitus, Type 2; Female; Follow-Up Studies; Furcation Defects; Gingival Overgrowth; Gingivitis; Humans; Male; Middle Aged; Periodontal Pocket; Subgingival Curettage; Tooth Mobility

Topics: Anti-Bacterial Agents; Azithromycin; Bone Regeneration; Gingival Overgrowth; Humans; Off-Label Use; Periodontitis

Azithromycin is effective for the remission of cyclosporine A-induced gingival overgrowth (CIGO) in persons who have undergone renal transplant. To explain its mechanism in alleviating the clinical symptoms of these individuals, we examined the effect of azithromycin on cell proliferation and collagen turnover modified by cyclosporin A in human gingival fibroblasts from healthy persons and from persons who had undergone renal transplant. Cyclosporin A-induced proliferation of renal transplant fibroblasts and normal fibroblasts was inhibited by azithromycin. Azithromycin elevated the reduced metalloproteinase (MMP)-1 and MMP-2 activities in cyclosporine A-treated renal transplant fibroblasts and normal fibroblasts. In cyclosporine A-treated renal transplant fibroblasts, azithromycin blocked the accumulation of total collagen in culture media and the increase in type I collagen mRNA level, but recovered the reduced MMP-2 mRNA level to the control. These results suggest that azithromycin may improve CIGO by blocking cyclosporine A-induced cell proliferation and collagen synthesis, and by activating MMP-2 in gingival fibroblasts of persons with cyclosporine A-induced gingival overgrowth.

Topics: Adult; Azithromycin; Cell Proliferation; Cells, Cultured; Chondrogenesis; Collagen Type I; Cyclosporine; Enzyme Activators; Female; Fibroblasts; Gingival Overgrowth; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Matrix Metalloproteinase 2; Middle Aged

Topics: Administration, Oral; Anti-Bacterial Agents; Anticonvulsants; Azithromycin; Drug Interactions; Epilepsy; Gingival Overgrowth; Humans; Phenytoin

Topics: Anti-Bacterial Agents; Azithromycin; Cyclosporine; Gingival Overgrowth; Humans; Immunosuppressive Agents; Metronidazole

The objective of the present study was to investigate the effect of cyclosporin A (CsA) and azithromycin (AZI) on collagen metabolism in the gingiva of rats.. Fifty 6-week-old male Sprague-Dawley (SD) rats (weight 120 to 150 g) were randomly distributed into five groups. All groups received various drugs via gastric feeding for 7 weeks. The first group (Mo group) received mineral oil for 7 weeks as a control; the CsA group received CsA in mineral oil for 7 weeks (dosage 30 mg/kg); the CsA/Mo group received CsA in mineral oil for 6 weeks and mineral oil only for the seventh week; the CsA/AZI group received CsA in mineral oil for 6 weeks and AZI (dosage 10 mg/kg) in mineral oil simultaneously with CsA in the seventh week; and the Mo/AZI group received mineral oil for 6 weeks and AZI in mineral oil for the seventh week. All animals were sacrificed for clinical and histological analyses. Gingival fibroblasts were cultured at the fourth passage, and the amount of collagen was measured. Type I collagen and collagenase mRNA were measured by reverse transcription-polymerase chain reaction. Collagen phagocytosis assay also was performed.. Clinically, CsA induced gingival overgrowth in rats, whereas AZI reduced gingival overgrowth. Histological results of the CsA group showed a marked increase of tissue volume compared to the other groups. High collagen amounts were found when gingival overgrowth was induced. However, type I collagen mRNA and collagenase mRNA expressions did not statistically differ among groups. Phagocytosis assay showed that CsA decreased phagocytic activity of gingival fibroblasts, whereas AZI increased the activity. These results suggest that the induction and reduction of CsA-induced gingival overgrowth were closely associated with phagocytic activity.. Cyclosporin A decreases collagen degradation by lowering phagocytic activity of rat gingival fibroblasts. Azithromycin partially compensates for this lowered phagocytic activity.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Cells, Cultured; Collagen Type I; Collagenases; Cyclosporine; Disease Models, Animal; Fibroblasts; Gingiva; Gingival Overgrowth; Immunosuppressive Agents; Male; Phagocytosis; Random Allocation; Rats; Rats, Sprague-Dawley; RNA, Messenger

Cyclosporin A (CsA) induces gingival overgrowth (GO) in up to a quarter of CsA-treated renal transplant recipients. A short-term therapy with azithromycin effectively reduces GO, indicating a possible involvement of microorganisms in the pathogenesis of CsA-induced GO. We aimed to determine if there could be any relationship between infection with Chlamydia pneumoniae and GO pathogenesis. In addition, we determined the long-term persistence rate of C. pneumoniae infection in residual GO tissue when azithromycin treatment failed to eliminate GO.. Chlamydia pneumoniae IgG and IgM antibody titres were measured by microimmunofluorescence technique in sera of kidney recipients with (n = 11) and without (n = 89) GO. GOs were rated and gingivectomies were performed before treatment with 500 mg of azithromycin for 3 days and at months 6 and 12 post-treatment when C. pneumoniae titres were re-evaluated. Nested polymerase chain reaction was performed to identify C. pneumoniae-specific DNA in GO tissues. Results of C. pneumoniae antibody titres from patients with GO were compared with pair-matched controls without GO.. Chlamydia pneumoniae IgM titres were elevated in five of 11 patients with GO and in none without GO, whereas the difference of C. pneumoniae IgG titres between patients with GO and pair-matched controls did not reach significance (P<0.57). Chlamydia pneumoniae-specific DNA was found in 10 of 11 GO tissue samples pre-treatment. Azithromycin therapy effectively reduced GO and C. pneumoniae IgM titres. In residual GO, C. pneumoniae-specific DNA remained detectable after 1 year in all GO tissue samples despite azithromycin treatment. The C.pneumoniae IgM titres correlated with GO scores.. Chlamydia pneumoniae infection is highly prevalent in CsA-induced GO. The infection can persist over a long period in residual GO despite short-term azithromycin therapy. The results indicate that CsA immunosuppression enhances C. pneumoniae infection rates in non-cardiovascular tissue.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Chlamydophila Infections; Chlamydophila pneumoniae; Cyclosporine; Female; Gingival Overgrowth; Humans; Immunoglobulin M; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Pneumonia, Bacterial; Prevalence; Time Factors; Treatment Failure

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Cyclosporine; Female; Gingival Overgrowth; Humans; Immunosuppressive Agents; Male; Middle Aged

Topics: Adult; Azithromycin; Calcium Channel Blockers; Creatinine; Cyclosporine; Gingival Overgrowth; Humans; Immunosuppressive Agents; Kidney Transplantation; Middle Aged