zithromax and Periodontal-Pocket

Past meta-analyses have shown adjunctive systemic Azithromycin (AZI) to provide minor clinical benefits in scaling and root surface debridement (S/RSD). However, these have not considered the covariance of key outcome parameters; probing pocket depth (PPD) and Clinical Attachment Level (CAL) or systematically examined some potential sources of heterogeneity.. To jointly synthesize 6-month outcomes of systemic AZI as adjunctive to S/RSD in chronic periodontitis and investigate 3 potential sources of heterogeneity.. Four databases were searched for suitable randomized controlled clinical trials (RCTs). Standardized mean differences (SMD) in PPD and CAL between AZI + S/RSD and S/RSD alone, at 6-month follow-up were computed. Within-study covariances of PPD and CAL were derived from reported multiple time-point data. A multivariate meta-analysis with random effects jointly modelled PPD and CAL, factoring in their covariance. This model included 3 moderators with interaction effects; timing of AZI initiation (pre-therapy/post-therapy), type of S/RSD [full-mouth debridement (FMD)/partial-mouth debridement (PMD)], and baseline study-level mean values of PPD/CAL.. Among 276 abstracts, 11 observations from 9 RCTs qualified for meta-analysis. Within-study correlation-coefficients of PPD with CAL significantly increased with increasing study-level baseline mean values (Spearman's r = 0.79, p < 0.01). The full multivariate meta-analysis model showed significant effects for the 3 moderators (Q statistic = 150.03, p < 0.01), retained significant residual heterogeneity (Q statistic = 88.50, p < 0.01) but outperformed (Likelihood- ratio statistic = 102.95, p < 0.01,) a null-model with no moderators (Q statistic = 201.5, p < 0.01). A significant effect was seen only on the SMD for PPD (estimate = 1.16 mm, 95% CI: 0.27 mm-2.07 mm mm, p = 0.01) but not CAL (estimate = 0.17 mm, 95% CI: -0.92 mm-1.26 mm, p = 0.76). SMD in PPD positively interacted with study baseline value (estimate = 0.11, 95% CI: 0.08-0.15, p < 0.01). Significant negative interactions of SMD in PPD with PMD (estimate = - 1.25 mm, 95% CI: -1.73 mm- -0.78 mm, p < 0.01) and pre-therapy drug initiation (estimate = - 1.18 mm, 95% CI: -1.48 mm--0.87 mm, p < 0.01) were evident.. Joint synthesis of PPD and CAL showed, at 6-months, AZI + S/RSD provided a benefit over S/RSD alone for PPD alone when correlation with CAL was accounted for. Deeper study-level baseline PPD, FMD type of S/RSD, and post-therapy drug initiation associated with greater PPD reduction.

Topics: Anti-Bacterial Agents; Azithromycin; Chronic Periodontitis; Debridement; Dental Care; Dental Scaling; Humans; Periodontal Pocket; Periodontitis; Treatment Outcome

The results of recent published studies focusing on the effect of azithromycin as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis are inconsistent. We conducted a meta-analysis of randomized controlled clinical trials to examine the effect of azithromycin combined with SRP on periodontal clinical parameters as compared to SRP alone. An electronic search was carried out on Pubmed, Embase and the Cochrane Central Register of Controlled Trials from their earliest records through December 28, 2014 to identify studies that met pre-stated inclusion criteria. Reference lists of retrieved articles were also reviewed. Data were extracted independently by two authors. Either a fixed- or random-effects model was used to calculate the overall effect sizes of azithromycin on probing depth, attachment level (AL) and bleeding on probing (BOP). Heterogeneity was evaluated using the Q test and I(2) statistic. Publication bias was evaluated by Begg's test and Egger's test. A total of 14 trials were included in the meta-analysis. Compared with SRP alone, locally delivered azithromycin plus SRP statistically significantly reduced probing depth by 0.99 mm (95% CI 0.42-1.57) and increased AL by 1.12 mm (95% CI 0.31-1.92). In addition, systemically administered azithromycin plus SRP statistically significantly reduced probing depth by 0.21 mm (95% CI 0.12-0.29), BOP by 4.50% (95% CI 1.45-7.56) and increased AL by 0.23 mm (95% CI 0.07-0.39). Sensitivity analysis yielded similar results. No evidence of publication bias was observed. The additional benefit of systemic azithromycin was shown at the initially deep probing depth sites, but not at shallow or moderate sites. The overall effect sizes of systemic azithromycin showed a tendency to decrease with time, and meta-regression analysis suggested a negative relation between the length of follow-up and net change in probing depth (r = -0.05, p = 0.02). This meta-analysis provides further evidence that azithromycin used as an adjunct to SRP significantly improves the efficacy of non-surgical periodontal therapy on reducing probing depth, BOP and improving AL, particularly at the initially deep probing depth sites.

Topics: Anti-Infective Agents; Azithromycin; Chronic Periodontitis; Dental Scaling; Gingival Hemorrhage; Humans; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Periodontitis; Randomized Controlled Trials as Topic; Root Planing

To investigate clinical, radiographic and microbiological outcome over 12 months following open flap debridement of peri-implantitis with or without antibiotics.. Peri-implantitis was surgically treated with or without Zithromax. The mean difference (reduction) in PPD values between baseline and month 12 in the test and control groups was 1.7 mm (SD ± 1.1, 95% CI: 1.1, 2.3, p < .001) and 1.6 mm (SD ± 1.5, 95% CI: 0.8, 2,4, p < .001), respectively. Data analysis failed to show study group differences for BOP, PPD, radiographic bone level and microbial load. Successful treatment (per protocol: PPD ≤ 5 mm, no BOP, no suppuration and no bone loss ≥0.5 mm) at 12 months in test and control groups was 7/15 (46.7%) and 4/16 (25.0%). Bacterial load reduction was similar in study groups with a temporary reduction following treatment.. Surgical treatment of peri-implantitis with adjunctive systemic azithromycin did not provide 1-year clinical benefits in comparison with those only receiving open flap debridement.

Topics: Adult; Aged; Aged, 80 and over; Alveolar Bone Loss; Anti-Bacterial Agents; Azithromycin; Bacterial Load; DNA, Bacterial; Female; Gingivitis; Humans; Middle Aged; Peri-Implantitis; Periodontal Debridement; Periodontal Index; Periodontal Pocket; Surgical Flaps; Sweden; Treatment Outcome

This study aimed to evaluate clinical and microbiological effects of systemic azithromycin (AZM) in adjunct to nonsurgical periodontal therapy (NSPT; or scaling root planing - SRP) in treatment of Aggregatibacter actinomycetemcomitans associated periodontitis (AAAP).. Seventy individuals with moderate to severe periodontitis and subgingival detection of A. actinomycetemcomitans were randomly allocated to two groups. Thirty-five individuals were allocated to full mouth SRP+AZM (500 mg oral delivery (OD) × 3 days) while 35 individuals were allocated to SRP+Placebo (OD × 3 days) group. The clinical variables evaluated were probing depth (PD), clinical attachment level (CAL), gingival index (GI), plaque index (PI), and percent bleeding on probing sites (%BOP), while microbiologic variables included percentage of subjects positive for A. actinomycetemcomitans at baseline, 3, 6, and 12 months.. The AZM group showed statistically significant reduction in mean PD (2.91 ± 0.88 mm) as compared to placebo (1.51 ± 0.98 mm) (P < 0.001), while CAL gain was significant in the AZM group (2.71 ± 1.15 mm) as compared to the placebo group (1.71 ± 1.29 mm) (P < 0.001). There was also a statistically significant reduction in the number of subjects positive for A. actinomycetemcomitans in the AZM group (P < 0.0001).. Azithromycin was found to significantly improve the clinical and microbiological parameters in AAAP individuals.

Topics: Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Azithromycin; Dental Scaling; Follow-Up Studies; Humans; Pasteurellaceae Infections; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Periodontitis; Root Planing

Conflicting data about the protocol of choice for non-surgical periodontal therapy with adjuvant use are still reported. This study aims to evaluate, through clinical and microbiologic parameters, the systemic use of azithromycin (AZ) and chlorhexidine (CHX) as adjuvants to non-surgical periodontal treatment performed by one-stage full-mouth disinfection (FMD) within 24 hours or conventional quadrant scaling (QS) in four weekly sections.. In this randomized controlled trial, 85 patients diagnosed with chronic periodontitis underwent different treatment protocols, in six groups: three FMD groups and three QS groups, each with no adjuvants, with CHX, and with AZ. Clinical periodontal parameters were recorded, and total and quantitative bacterial counts of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Streptococcus oralis were measured with real-time polymerase chain reaction at baseline and 90 and 180 days after treatment.. In all groups, a significant reduction was observed in the percentage of periodontal diseased sites, gingival index, plaque index, and clinical attachment level gain at 90 days, demonstrating effectiveness of the treatment, independently of the adjuvant. The FMD with CHX group showed higher reduction in probing depth and percentage of periodontal diseases sites, as well as lower total bacterial count, than all the other groups at 180 days.. The adjuvant use of AZ did not provide any significant benefit, independently of the treatment protocol. The adjuvant use of CHX showed a more expressive and significant improvement in clinical and microbiologic parameters, especially in the FMD protocol, followed by QS.

Topics: Aggregatibacter actinomycetemcomitans; Anti-Infective Agents, Local; Azithromycin; Chlorhexidine; Dental Scaling; Disinfection; Follow-Up Studies; Humans; Periodontal Index; Periodontal Pocket; Root Planing

To compare immediate surgery to scaling and root planing (SRP) in the treatment of advanced periodontal disease focusing on the prevalence of residual sites and cost-effectiveness (1); to evaluate the adjunctive effects of azithromycin in a second treatment phase (2).. Thirty-nine patients (18 males, 21 females; mean age: 54.6) received oral hygiene instructions and were randomly allocated to surgery (n = 19) or SRP (n = 20). Patients with residual pockets (≥6 mm) at 6 months received re-debridement of these sites and systemic azithromycin. Treatment groups were followed up to 12 months and evaluated in terms of clinical response parameters and cost-effectiveness. Chair-time was used to assess the financial impact of treatment.. Both treatment arms were equally effective in terms of clinical outcome demonstrating less than 1% residual pockets at 12 months. Surgery imposed an extra 746 Euro on the patient up to 6 months when compared to SRP. At 12 months, 46 Euro of this amount could be offset as a result of a reduced need for supportive care. Only 6 patients in the surgery group needed systemic antibiotics, whereas 14 patients in the SRP needed such additional treatment.. Although 700 Euro could be saved on average by performing SRP instead of surgery, the latter significantly reduced the need for supportive care and systemic antibiotics.

Topics: Adult; Aged; Anti-Bacterial Agents; Azithromycin; Chronic Periodontitis; Combined Modality Therapy; Cost-Benefit Analysis; Dental Plaque Index; Dental Scaling; Drug Costs; Female; Follow-Up Studies; Health Care Costs; Humans; Male; Middle Aged; Oral Hygiene; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Prospective Studies; Root Planing; Single-Blind Method; Time Factors; Treatment Outcome

The purpose of the study was to compare the clinical response to two regimes of azithromycin use in the complex of non-surgical periodontal therapy. After initial periodontal therapy of chronic generalized periodontitis (CGP), 60 patients were randomly assigned to three groups. In group I patients underwent standard medical care; In group II - patients underwent standard medical care and azithromycin: 500 mg once per day, during 3 days; In group III: 500 mg once per day, during 7 days, followed by 500 mg once per week during 12 weeks. Clinical periodontal indices were recorded before treatment and after 1, 3, 6, and 12 months. In group I after 3 months of treatment the clinical effect was lost in 65% of patients. In group III after 12 months clinical effect persisted in 80% of cases. CGP exacerbations frequency was significantly lower in group III compared with group I (χ2=8,03; р=0,0046). The long-term azithromycin at the CGP results in significantly clinical benefit of 80% patients for at least one year and satisfactorily tolerated.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Chronic Periodontitis; Female; Hemorrhage; Humans; Male; Middle Aged; Periodontal Index; Periodontal Pocket; Treatment Outcome

Periodontitis may alter the systemic condition in patients with diabetes and hence interfere with glycemic control. The objective of this study was to determine the quantifiable changes in glycated hemoglobin (HbA1C) after periodontal non-surgical therapy plus azithromycin in a mixed population of patients with poorly controlled diabetes.. One hundred and five patients were randomized to receive non-surgical therapy plus azythromycin (AZ-Sca =33), non-surgical therapy plus placebo (PB-Sca = 37) and supragingival prophylaxis plus azithromycin (AZ-Pro = 35). Glycated hemoglobin, glycemia and periodontal parameters were measured at baseline, 3, 6 and 9 mo after treatment.. Periodontal parameters were improved in the AZ-Sca and PB-Sca groups as compared to the AZ-Pro group. A greater reduction in probing depth was observed in the AZ-Sca as compared to the PB-Sca group. Improvement in clinical attachment level was similar between AZ-Sca and PB-Sca groups. A reduction from 8.0% to 7.2% (∆0.8%; p < 0.05) in HbA1C was observed in the AZ-Sca at 9 mo as compared to the PB-Sca group in which the reduction was from 7.9% to 7.6% (∆0.3%). There was no decrease in HbA1C in the AZ-Pro group over time. Mean glycemia values decreased from 195 mg/dL to 159.2 mg/dL (∆35.8 mg/dL; p < 0.05) in the AZ-Sca group whereas a decrease from 194 mg/dL to 174.8 mg/dL (∆19.2 mg/dL) in the PB-Sca group at 9 mo was observed. There were no differences between the AZ-Sca and PB-Sca groups for glycemic parameters. No improvement in glycemic values in the AZ-Pro group was observed.. A modest improvement in glycemic control was detected with a trend towards the use of non-surgical therapy plus AZ as compared to the placebo.

Topics: Anti-Bacterial Agents; Azithromycin; Blood Glucose; Combined Modality Therapy; Dental Prophylaxis; Dental Scaling; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Double-Blind Method; Female; Follow-Up Studies; Glycated Hemoglobin; Humans; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Debridement; Periodontal Index; Periodontal Pocket; Periodontitis; Placebos

One-stage full-mouth scaling and root planing (FM-SRP) in combination with systemically administered azithromycin was shown to be clinically and bacteriologically effective in the treatment of chronic periodontitis. However, FM-SRP requires 2 hours for completion. Azithromycin has a long half-life. Therefore, if SRP of the full mouth is performed within 7 days while an effective concentration of azithromycin remains in the gingiva, the effects may be the same as FM-SRP. The aim of this study was to compare the clinical and bacteriologic effects of FM-SRP and partial-mouth scaling and root planing (PM-SRP) in patients with chronic periodontitis, which was performed in three sessions within 7 days, during the effective half-life of systemically administrated azithromycin.. Thirty adult subjects with chronic periodontitis were randomly divided into three groups (FM-SRP, PM-SRP, and control). A clinical examination was conducted to record the probing depth, clinical attachment level gain, bleeding on probing, gingival index, and volume of gingival crevicular fluid; bacterial samples were obtained before treatment and 1, 3, 6, 9, and 12 months thereafter. Quantitative and qualitative analyses were performed using the polymerase chain reaction-Invader method.. All clinical parameters showed better improvement in FM-SRP and PM-SRP groups compared to the control group, with no significant differences between the two test groups. Periodontal bacteria were well controlled in the two test groups, but they tended to increase gradually 3 months after treatment in the control group.. PM- and FM-SRP demonstrated comparable clinical and bacteriologic results.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Azithromycin; Bacteroides; Chronic Periodontitis; Dental Scaling; Double-Blind Method; Female; Follow-Up Studies; Gingiva; Gingival Crevicular Fluid; Gingival Hemorrhage; Half-Life; Humans; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Porphyromonas gingivalis; Prevotella intermedia; Root Planing; Treatment Outcome; Treponema denticola

To assess the effect of systemic azithromycin as a supplement to scaling and root planing (SRP) in the treatment of aggressive periodontitis (AgP).. Twenty-four individuals (13-26 years old) underwent a plaque control program, and then were treated with SRP. Subjects were assigned randomly into two groups; the test group used 500 mg azithromycin once a day for 3 days, whereas the control group used a placebo. Clinical variables were assessed at baseline, 3, 6, 9, and 12 months. The periodontal status at baseline and 12 months was compared using the Wald test, and adjusting for the effect of clustering of teeth within subjects.. There were no significant differences in visible plaque, gingival bleeding, and supragingival calculus between groups throughout the study. Periodontal probing depth (PPD) and clinical attachment level improved significantly from baseline to 12 months in both groups, with the test group showing significantly more reduction in mean PPD compared with controls (2.88 mm versus 1.85 mm, respectively, p=0.025). Subjects administering azithromycin showed a higher percentage of teeth with attachment gain >or=1 mm (81.34 versus 63.63, p=0.037), whereas the controls had higher percentage of teeth with attachment loss >or=1 mm (11.57 versus 2.24, p=0.015).. The adjunctive use of azithromycin has the potential to improve periodontal health of young patients with AgP.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Combined Modality Therapy; Dental Calculus; Dental Plaque; Dental Scaling; Double-Blind Method; Female; Follow-Up Studies; Gingival Hemorrhage; Gingival Recession; Humans; Male; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Placebos; Root Planing; Subgingival Curettage

Recent developments suggest that the local delivery of antimicrobials into periodontal pockets can improve periodontal health. The present study was undertaken to investigate the clinical and microbiologic effectiveness of azithromycin (AZM) at 0.5% concentration in an indigenously prepared bioabsorbable controlled-release gel as an adjunct to non-surgical mechanical therapy in the treatment of chronic periodontitis.. Eighty patients were categorized into two treatment groups: scaling and root planing (SRP) only (group 1) and SRP plus 0.5% AZM (group 2). Clinical parameters were recorded at baseline and 1, 2, and 3 months; they included modified gingival index, modified sulcus bleeding index, probing depth (PD), and clinical attachment level (CAL). At baseline and 6 and 12 weeks, microbiologic assessment was done of the percentage of morphologically different microorganisms (coccoid cells, others [straight rods, filaments, and fusiforms], motile rods, and spirochetes) using darkfield microscopy. The mean concentration of 0.5% AZM in gingival crevicular fluid was estimated by reverse phase high performance liquid chromatography.. Both therapies resulted in significant improvements. Mean PD reduction from baseline to 3 months was 2.13 +/- 0.35 mm and 2.53 +/- 0.52 in groups 1 and 2, respectively. Mean CAL gain from baseline to 3 months was 0.60 +/- 0.63 mm and 1.07 +/- 0.70 mm in groups 1 and 2, respectively. All microbiologic categories showed significant improvement in both groups, with greater improvement in the test group. The mean concentration of AZM at all observed periods (baseline to 28 days) provided sufficient antimicrobial activity (>2 microg/ml) and fulfilled the conditions for a controlled-release device.. Although both treatment strategies seemed to benefit the patients, the adjunctive use of 0.5% AZM as a controlled drug-delivery system enhanced the clinical and microbiologic results as shown by the intergroup comparison.

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Azithromycin; Chronic Periodontitis; Colony Count, Microbial; Combined Modality Therapy; Delayed-Action Preparations; Dental Scaling; Follow-Up Studies; Gels; Gingival Crevicular Fluid; Humans; Middle Aged; Periodontal Index; Periodontal Pocket; Treatment Outcome

To compare clinical changes occurring in chronic periodontitis subjects receiving SRP alone or with systemically administered azithromycin, metronidazole or a sub-antimicrobial dose of doxycycline.. 92 chronic periodontitis subjects were randomly assigned to receive SRP alone (N=23) or combined with 500 mg azithromycin per day for 3 days (N=25), 250 mg metronidazole tid for 14 days (N=24) or 20 mg doxycycline bid for 3 months (N=20). Gingival redness, bleeding on probing, suppuration, pocket depth and attachment level were measured at baseline and 3, 6 and 12 months post therapy. The significance of changes in clinical parameters within groups over time was sought using the Friedman test and among groups using ANCOVA or the Kruskal Wallis test.. All groups showed clinical improvements at 12 months, with subjects receiving adjunctive agents showing a somewhat better response. Sites with initial pocket depth > 6 mm showed significantly greater pocket depth reduction and greater attachment gain in subjects receiving metronidazole or azithromycin than subjects in the other groups. Some subjects showed attachment loss at 12 months in each group ranging from 15% to 39% of subjects in the SDD and SRP only groups respectively.. This study, demonstrated that periodontal therapy provides clinical benefits and that antibiotics provide a clinical benefit over SRP alone, particularly at initially deeper periodontal pockets.

Topics: Adult; Aged; Anti-Bacterial Agents; Azithromycin; Chronic Disease; Combined Modality Therapy; Dental Scaling; Doxycycline; Epidemiologic Methods; Female; Humans; Male; Metronidazole; Middle Aged; Periodontal Pocket; Periodontitis; Root Planing

One-stage full-mouth disinfection (FMD), in which full-mouth scaling and root planing (SRP) is performed with adjunctive use of chlorhexidine, was introduced in 1995. There have been several reports on the effectiveness of this treatment protocol. However, FMD was reported to induce pyrexia frequently. We examined the effects of full-mouth SRP in conjunction with azithromycin administered orally before SRP to control the number of bacteria. The purpose of this study was to compare the effects of full-mouth SRP using azithromycin with conventional SRP.. Thirty-four subjects (17 in the test group and 17 in the control group) with severe chronic periodontitis were selected. The subjects of the test group had azithromycin 3 days before full-mouth SRP. Clinical parameters (probing depth [PD], gingival index [GI], bleeding on probing [BOP], and gingival crevicular fluid [GCF]), total number of bacteria, and number of black pigment-producing rods (BPRs) were evaluated at baseline and 5, 13, and 25 weeks after baseline.. All clinical parameters improved in the test group more than in the control group. In the bacteriologic examination, the total number of bacteria did not change during the examination. In the test group, BPRs were not detected until 13 weeks. However, BPRs were detected in the control group by 13 weeks.. It was shown that full-mouth SRP using systemically administered azithromycin was a clinically and bacteriologically useful basic periodontal treatment for severe chronic periodontitis.

Topics: Administration, Oral; Anti-Bacterial Agents; Azithromycin; Bacteria, Anaerobic; Body Temperature; Chronic Disease; Colony Count, Microbial; Combined Modality Therapy; Dental Scaling; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Periodontal Index; Periodontal Pocket; Periodontitis; Preoperative Care; Root Planing

Antibiotic therapy can be used in very specific periodontal treatment situations such as in refractory cases of periodontal disease found to be more prevalent in smokers. This study was designed to determine the efficacy of azithromycin (AZM) when combined with scaling and root planing (SRP) for the treatment of moderate to severe chronic periodontitis in smokers.. Thirty-one subjects were enrolled into a 6-month randomized, single-masked trial to evaluate clinical, microbial (using benzoyl- DL-arginine naphthylamine [BANA] assay), and gingival crevicular fluid (GCF) pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP) levels in response to SRP alone or SRP + AZM. At baseline, patients who smoked > or =1 pack per day of cigarettes who presented with at least five sites with probing depths (PD) of > or =5 mm with bleeding on probing (BOP) were randomized into the test or control groups. At baseline and 3 and 6 months, clinical measurements (probing depth [PD], clinical attachment loss [CAL], and bleeding on probing [BOP]) were performed. GCF bone marker assessment (Ctelopeptide [ICTP] as well as BANA test analyses) were performed at baseline, 14 days, and 3 and 6 months.. The results demonstrated that both groups displayed clinical improvements in PD and CAL that were sustained for 6 months. Using a subject-based analysis, patients treated with SRP + AZM showed enhanced reductions in PD and gains in CAL at moderate (4 to 6 mm) and deep sites (>6 mm) (P <0.05). Furthermore, SRP + AZM resulted in greater reductions in BANA levels compared to SRP alone (P <0.05) while rebounds in BANA levels were noted in control group at the 6-month evaluation. No statistically significant differences between groups on mean BOP and ICTP levels during the course of the study were noted.. The utilization of AZM in combination with SRP improves the efficacy of non-surgical periodontal therapy in reducing probing depth and improving attachment levels in smokers with moderate to advanced attachment loss.

Topics: Adult; Aged; Anti-Bacterial Agents; Azithromycin; Benzoylarginine-2-Naphthylamide; Chronic Disease; Collagen Type I; Dental Scaling; Female; Follow-Up Studies; Gingival Crevicular Fluid; Gingival Hemorrhage; Humans; Male; Middle Aged; Peptide Fragments; Peptides; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Procollagen; Root Planing; Single-Blind Method; Smoking; Treatment Outcome

The aim of the study was to investigate the clinical and microbiological effects of azithromycin as an adjunct to the non-surgical treatment of periodontitis in adults. Azithromycin is an antibiotic which is taken up by phagocytes and is released over long periods in inflamed tissue but requires a total of only three doses of 500 mg to produce its therapeutic effect.. 46 patients were treated in a double-blind placebo-controlled study with assessments at weeks 0, 1, 2, 3, 6, 10 and 22. Throughout the trial measurements were made of plaque, gingival bleeding, calculus, probing pocket depths and bleeding on probing. Microbiological sampling was carried out from a selected pocket >or=6 mm at each visit. The regime employed consisted of OHI, scaling and root planing at weeks 0, 1 and 2 with reinforcement of OHI and minimal scaling at weeks 6, 10 and 22. Patients were randomly assigned to receive either azithromycin, (A), or placebo capsules, (C), 500 mg, 1x daily for 3 days at week 2. 44 patients completed the study. Mean pocket depths were analysed using analysis of covariance in 3 groups with initial pocket depth values of 1-3 mm, 4-5 mm and >or=6 mm.. The results of the microbiology have been reported in a separate paper. The clinical data showed that by week 22 a lower % of pockets initially >5 mm deep remained above that level in the 23 patients taking azithromycin (A), than the 21 taking the placebo (C), (A, 5.6%; C, 23.3%). Also at week 22, for pockets initially 4 mm or more, the test group had fewer pockets >3 mm deep (A, 26.1%; C, 44.3%), fewer failing to improve in probing depth (A, 6.6%; C, 21.6%) and fewer continuing to bleed on probing (A, 46.9%; C, 55.6%) when compared with the control group. Pocket depths initially 4-5 mm or 6-9 mm analysed by analysis of covariance showed lower mean pocket depths in the patients on azithromycin, at weeks 6, 10 and 22, (pockets initially 4-5 mm, p<0.001 on all occasions, pockets initially 6-9 mm, p<0.001, week 6; p< 0.003, week 10; p<0.001, week 22).. Azithromycin may be a useful adjunct in the treatment of adult periodontitis, particularly where deep pockets are present.

Topics: Adult; Analysis of Variance; Anti-Bacterial Agents; Azithromycin; Chemotherapy, Adjuvant; Dental Plaque Index; Dental Scaling; Double-Blind Method; Humans; Periodontal Index; Periodontal Pocket; Periodontitis; Reproducibility of Results; Treatment Outcome

Azithromycin is an azalide antibiotic with excellent in vitro activity against a wide variety of oral bacteria. It has a long half-life, good tissue penetration and is preferentially taken up by phagocytes. We investigated the microbiological efficacy of azithromycin as an adjunct to the non-surgical treatment of adult chronic periodontitis; its clinical efficacy is dealt with in a separate paper. 46 patients were treated in a double-blind placebo controlled trial. Microbiological assessment of the same periodontal pocket (initially > 6 mm) was made at weeks 0, 2, 3, 6, 10 and 22. Either azithromycin 500 mg 1 x daily for 3 days or placebo was given at week 2. Particular attention was paid to the numbers of black pigmented anaerobes and spirochaetes present since these are the most commonly implicated pathogens in periodontal disease. Pigmented anaerobes were significantly reduced at weeks 3 and 6 in patients who received azithromycin compared to placebo and remained lower, although not significantly so, throughout the study. Counts of spirochaetes were significantly reduced throughout the study in patients who received azithromycin compared to placebo. Our microbiological study suggests that azithromycin may be useful as an adjunct in the treatment of periodontal disease.

Topics: Adult; Analysis of Variance; Anti-Bacterial Agents; Azithromycin; Bacteria, Anaerobic; Colony Count, Microbial; Double-Blind Method; Female; Humans; Male; Microbial Sensitivity Tests; Periodontal Pocket; Periodontitis; Spirochaetales; Statistics, Nonparametric

Sitafloxacin (STFX) is a newly developed quinolone that has robust antimicrobial activity against periodontopathic bacteria. We previously reported that oral administration of STFX during supportive periodontal therapy was as effective as conventional mechanical debridement under local anesthesia microbiologically and clinically for 3 months. The aim of the present study was to examine the short-term and long-term microbiological and clinical effects of systemic STFX and azithromycin (AZM) on active periodontal pockets during supportive periodontal therapy. Fifty-one patients receiving supportive periodontal therapy were randomly allocated to the STFX group (200 mg/day of STFX for 5 days) or the AZM group (500 mg/day of AZM for 3 days). The microbiological and clinical parameters were examined until 12 months after the systemic administration of each drug. The concentration of each drug in periodontal pockets and the antimicrobial susceptibility of clinical isolates were also analyzed. The proportions of red complex bacteria, i.e., Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, which are the representative periodontopathic bacteria, were significantly reduced at 1 month and remained lower at 12 months than those at baseline in both the STFX and AZM groups. Clinical parameters were significantly improved over the 12-month period in both groups. An increase in the MIC of AZM against clinical isolates was observed in the AZM group. These results indicate that monotherapy with systemic STFX and AZM might be an alternative treatment during supportive periodontal therapy in patients for whom invasive mechanical treatment is inappropriate. (This study has been registered with the University Hospital Medical Information Network-Clinical Trials Registry [UMIN-CTR] under registration number UMIN000007834.).

Topics: Administration, Oral; Adult; Aged; Anti-Bacterial Agents; Azithromycin; Female; Fluoroquinolones; Humans; Male; Middle Aged; Periodontal Pocket; Periodontitis; Periodontium; Porphyromonas gingivalis; Tannerella forsythia; Treponema denticola

Azithromycin is an antibiotic belonging to the macrolides. Previous case reports showed that azithromycin has a regenerative effect on periodontal tissue in addition to improving periodontal gingival inflammation. Recently, we experienced three periodontitis cases, all of which showed severe bone loss. However, their gingival inflammatory signs differed greatly. The present case reports evaluated the regenerative effects of azithromycin on periodontitis sites with different clinical signs of gingival inflammation.. In Case 1, generalized chronic periodontitis with severe gingival inflammation was treated with azithromycin before periodontal treatment. In contrast, Case 2 presented with few clinical signs of gingival inflammation, but was treated with azithromycin prescribed within a day of scaling and root planing. In Case 3, teeth with moderate gingival inflammation were treated with azithromycin after a series of scaling and root planing.. Remarkable alveolar bone growth, regardless of baseline gingival inflammation, was noted in all three cases.. The use of adjunctive azithromycin in scaling and root planing may be effective for periodontal tissue regeneration. This property may be independent of the degree of baseline gingival inflammation.

Topics: Adult; Aged; Alveolar Bone Loss; Alveolar Process; Anti-Bacterial Agents; Azithromycin; Bone Regeneration; Dental Scaling; Female; Gingivitis; Humans; Male; Middle Aged; Periodontal Pocket; Periodontitis; Periodontium; Root Planing

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

Azithromycin is an azalide antibiotic, effective against a wide range of oral bacteria including periodontopathic bacteria. Azithromycin is taken up by phagocytes and is released into inflamed tissue over time. The concentration of azithromycin in inflamed periodontal tissues over time has not been studied. In this study, we determined the azithromycin concentration in the gingiva and inflammatory connective tissue of the periodontal pocket in periodontal patients who had been administered azithromycin systemically. We also evaluated the clinical and microbiologic effects of azithromycin.. Thirty-four patients with periodontitis were prescribed azithromycin 500 mg once daily for 3 days. During the 14-day study, clinical parameters (probing depth, gingival index, bleeding on probing, and gingival crevicular fluid level) were recorded, subgingival plaque was collected for bacteriologic examination, and the azithromycin concentration in the tissues lining the periodontal pocket was measured by agar diffusion bioassay.. Clinical parameters significantly improved after administration of azithromycin. The total number of cultivated bacteria also significantly decreased by day 4 but slightly increased after day 7. Sustained reduction in levels of six periodontopathic bacteria was not apparent until day 14. On day 7, the azithromycin concentration in the tissues lining the periodontal pockets was 50% of that on day 4, and on day 14 only 20%.. Azithromycin is detectable in inflamed periodontal tissues >or=14 days after systemic administration; it is associated with clinical and microbiologic improvement.

Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Azithromycin; Connective Tissue; Female; Follow-Up Studies; Humans; Male; Middle Aged; Periodontal Pocket; Periodontium; Time Factors