Effect of Periodontal Debridement plus Systemic Azithromycin in subjects with Stage III Periodontitis: A Randomized Controlled Clinical Trial.
Abstract
Aim: To evaluate the effect of the systemic administration of azi-thromycin (AZM) as an adjunct to non-surgical periodontal therapy (NSPT) on the clinical and microbiological variables of patients with periodontitis
Material and Methods: Eighteen volunteers received NSPT combined with placebo or AZM (500 mg/day) for 3 days (n=9/group). They were monitored clinically for probing pocket depth (PPD), clinical attachment level (CAL), O'Leary index (OI), bleeding on probing (BoP) at baseline and during the first, third and sixth month and microbiologically, at baseline and at 3 and 6 months after therapy, by conventional polymerase chain reaction tests.
Results: Fourteen patients completed the study (n=7/group). Differences statistically significant were observed among both groups. The experimental group presented: A PPD mean (p=0.04) significantly lower and PPD reduction (p=0.02), at 6-months post NSPT. Regarding changes (∆), at the third month post NSPT, there was a significant increase in the number of shallow sites (p<0.001) and a decrease in the intermediate sites (p<0.001). In addition, a significant decrease in the mean number of deep sites (p=0.04) was detected at 6 months post treatment. There was also a significant decrease in periodontal index BoP at 1 (p=0.01), 3 (p<0.001) and 6 (p=0.01) months and OI at 3- and 6-months (p<0.001), post treatment. Regarding the presence of periodontal pathogens, no significant differences were observed, intra and inter groups.
Conclusion: AZM as an adjuvant to NSPT provides additional beneficial effects for PPD and BoP compared to NSPT alone.
References
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[24]. Zandbergen D, Slot DE, Niederman R, Van der Weijden FA. The concomitant administration of systemic amoxicillin and metronidazole compared to scaling and root planing alone in treating periodontitis: =a systematic review=. BMC Oral Health. 2016 Feb 29;16:27. doi: 10.1186/s12903-015-0123-6. PMID: 26928597; PMCID: PMC4770674.
[25]. Yashima A, Gomi K, Maeda N, Arai T. One-stage full-mouth versus partial-mouth scaling and root planing during the effective half-life of systemically administered azithromycin. J Periodontol. 2009 Sep;80(9):1406-13. doi: 10.1902/jop.2009.090067. PMID: 19722790.
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[28]. Hajishengallis G, Lamont RJ. Polymicrobial communities in periodontal disease: Their quasi-organismal nature and dialogue with the host. Periodontol 2000. 2021;86(1):210-230. doi: 10.1111/prd.12371. Epub 2021 Mar 10. PMID: 33690950; PMCID: PMC8957750.
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[2]. Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of severe periodontitis in 1990-2010: a systematic review and meta-regression. J Dent Res. 2014 Nov;93(11):1045-53. doi: 10.1177/0022034514552491. Epub 2014 Sep 26. PMID: 25261053; PMCID: PMC4293771
[3]. O'Rourke VJ. Azithromycin as an adjunct to non-surgical periodontal therapy: a systematic review. Aust Dent J. 2017;62(1):14-22. doi: 10.1111/adj.12448. Epub 2017 Feb 3. PMID: 27492140.
[4]. Laine ML, Crielaard W, Loos BG. Genetic susceptibility to periodontitis. Periodontol 2000. 2012 Feb;58(1):37-68. doi: 10.1111/j.1600-0757.2011.00415.x. PMID: 22133366.
[5]. Feres M, Figueiredo LC, Soares GM, Faveri M. Systemic antibiotics in the treatment of periodontitis. Periodontol 2000. 2015 Feb;67(1):131-86. doi: 10.1111/prd.12075. PMID: 25494600.
[6]. Oteo A, Herrera D, Figuero E, O'Connor A, González I, Sanz M. Azithromycin as an adjunct to scaling and root planing in the treatment of Porphyromonas gingivalis-associated periodontitis: a pilot study. J Clin Periodontol. 2010 Nov;37(11):1005-15. doi: 10.1111/j.1600-051X.2010.01607.x. Epub 2010 Aug 23. PMID: 20735515.
[7]. Gannon SC, Cantley MD, Haynes DR, Hirsch R, Bartold PM. Azithromycin suppresses human osteoclast formation and activity in vitro. J Cell Physiol. 2013;228(5):1098-107. doi: 10.1002/jcp.24259. PMID: 23065774.
[8]. Muniz FW, de Oliveira CC, de Sousa Carvalho R, Moreira MM, de Moraes ME, Martins RS. Azithromycin: a new concept in adjuvant treatment of periodontitis. Eur J Pharmacol. 2013 Apr 5;705(1-3):135-9. doi: 10.1016/j.ejphar.2013.02.044. Epub 2013 Mar 13. PMID: 23499686.
[9]. Hirsch R, Deng H, Laohachai MN. Azithromycin in periodontal treatment: more than an antibiotic. J Periodontal Res. 2012 Apr;47(2):137-48. doi: 10.1111/j.1600-0765.2011.01418.x. Epub 2011 Nov 4. PMID: 22050485.
[10]. Sampaio E, Rocha M, Figueiredo LC, Faveri M, Duarte PM, Gomes Lira EA, Feres M. Clinical and microbiological effects of azithromycin in the treatment of generalized chronic periodontitis: a randomized placebo-controlled clinical trial. J Clin Periodontol. 2011 Sep;38(9):838-46. doi: 10.1111/j.1600-051X.2011.01766.x. Epub 2011 Jul 19. PMID: 21770996.
[11]. Lang NP, Tonetti MS. Periodontal risk assessment (PRA) for patients in supportive periodontal therapy (SPT). Oral Health Prev Dent. 2003;1(1):7-16. PMID: 15643744.
[12]. Buset SL, Zitzmann NU, Weiger R, Walter C. Non-surgical periodontal therapy supplemented with systemically administered azithromycin: a systematic review of RCTs. Clin Oral Investig. 2015 Nov;19(8):1763-75. doi: 10.1007/s00784-015-1499-z. Epub 2015 Jun 12. PMID: 26063646.
[13]. Renatus A, Herrmann J, Schönfelder A, Schwarzenberger F, Jentsch H. Clinical Efficacy of Azithromycin as an Adjunctive Therapy to Non-Surgical Periodontal Treatment of Periodontitis: A Systematic Review and Meta-Analysis. J Clin Diagn Res. 2016 Jul;10(7):ZE01-7. doi: 10.7860/JCDR/2016/20176.8115. Epub 2016 Jul 1. PMID: 27630968; PMCID: PMC5020305.
[14]. Pretzl B, Sälzer S, Ehmke B, Schlagenhauf U, Dannewitz B, Dommisch H, Eickholz P, Jockel-Schneider Y. Administration of systemic antibiotics during non-surgical periodontal therapy-a consensus report. Clin Oral Investig. 2019 Jul;23(7):3073-3085. doi: 10.1007/s00784-018-2727-0. Epub 2018 Oct 29. PMID: 30374830.
[15]. Saleh A, Rincon J, Tan A, Firth M. Comparison of adjunctive azithromycin and amoxicillin/metronidazole for patients with chronic periodontitis: preliminary randomized control trial. Aust Dent J. 2016 Dec;61(4):469-481. doi: 10.1111/adj.12415. PMID: 26836781.
[16]. Morales A, Contador R, Bravo J, Carvajal P, Silva N, Strauss FJ, Gamonal J. Clinical effects of probiotic or azithromycin as an adjunct to scaling and root planning in the treatment of stage III periodontitis: a pilot randomized controlled clinical trial. BMC Oral Health. 2021 Jan 7;21(1):12. doi: 10.1186/s12903-020-01276-3. PMID: 33413320; PMCID: PMC7792194.
[17]. Zhang Z, Zheng Y, Bian X. Clinical effect of azithromycin as an adjunct to non-surgical treatment of chronic periodontitis: a meta-analysis of randomized controlled clinical trials. J Periodontal Res. 2016 Jun;51(3):275-83. doi: 10.1111/jre.12319. Epub 2015 Sep 12. PMID: 26362529.
[18]. Morales A, Gandolfo A, Bravo J, Carvajal P, Silva N, Godoy C, Garcia-Sesnich J, Hoare A, Diaz P, Gamonal J. Microbiological and clinical effects of probiotics and antibiotics on nonsurgical treatment of chronic periodontitis: a randomized placebo- controlled trial with 9-month follow-up. J Appl Oral Sci. 2018;26:e20170075. doi: 10.1590/1678-7757-2017-0075. PMID: 29364340; PMCID: PMC5777419.
[19]. Parnham MJ, Erakovic Haber V, Giamarellos-Bourboulis EJ, Perletti G, Verleden GM, Vos R. Azithromycin: mechanisms of action and their relevance for clinical applications. Pharmacol Ther. 2014 Aug;143(2):225-45. doi: 10.1016/j.pharmthera.2014.03.003. Epub 2014 Mar 11. PMID: 24631273.
[20]. Teughels W, Feres M, Oud V, Martín C, Matesanz P, Herrera D. Adjunctive effect of systemic antimicrobials in periodontitis therapy: A systematic review and meta-analysis. J Clin Periodontol. 2020 Jul;47 Suppl 22:257-281. doi: 10.1111/jcpe.13264. PMID: 31994207.
[21]. Nakajima T, Okui T, Ito H, Nakajima M, Honda T, Shimada Y, Tabeta K, Akazawa K, Yamazaki K. Microbiological and Clinical Effects of Sitafloxacin and Azithromycin in Periodontitis Patients Receiving Supportive Periodontal Therapy. Antimicrob Agents Chemother. 2016 Jan 4;60(3):1779-87. doi: 10.1128/AAC.02575-15. PMID: 26729495; PMCID: PMC4775917.
[22]. Martande SS, Pradeep AR, Singh SP, Kumari M, Naik SB, Suke DK, Singh P. Clinical and microbiological effects of systemic azithromycin in adjunct to nonsurgical periodontal therapy in treatment of Aggregatibacter actinomycetemcomitans associated periodontitis: a randomized placebo-controlled clinical trial. J Investig Clin Dent. 2016 Feb;7(1):72-80. doi: 10.1111/jicd.12115. Epub 2014 Jul 17. PMID: 25044531.
[23]. Kornman KS, Newman MG, Moore DJ, Singer RE. The influence of supragingival plaque control on clinical and microbial outcomes following the use of antibiotics for the treatment of periodontitis. J Periodontol. 1994 Sep;65(9):848-54. doi: 10.1902/jop.1994.65.9.848. PMID: 7990021.
[24]. Zandbergen D, Slot DE, Niederman R, Van der Weijden FA. The concomitant administration of systemic amoxicillin and metronidazole compared to scaling and root planing alone in treating periodontitis: =a systematic review=. BMC Oral Health. 2016 Feb 29;16:27. doi: 10.1186/s12903-015-0123-6. PMID: 26928597; PMCID: PMC4770674.
[25]. Yashima A, Gomi K, Maeda N, Arai T. One-stage full-mouth versus partial-mouth scaling and root planing during the effective half-life of systemically administered azithromycin. J Periodontol. 2009 Sep;80(9):1406-13. doi: 10.1902/jop.2009.090067. PMID: 19722790.
[26]. Almalki ZS, Guo JJ. Cardiovascular events and safety outcomes associated with azithromycin therapy: a meta-analysis of randomized controlled trials. Am Health Drug Benefits. 2014 Sep;7(6):318-28. PMID: 25558301; PMCID: PMC4280524.
[27]. Reed LA, O'Bier NS, Oliver LD Jr, Hoffman PS, Marconi RT. Antimicrobial activity of amixicile against Treponema denticola and other oral spirochetes associated with periodontal disease. J Periodontol. 2018;89(12):1467-1474. doi: 10.1002/JPER.17-0185. Epub 2018 Sep 5. PMID: 29958324.
[28]. Hajishengallis G, Lamont RJ. Polymicrobial communities in periodontal disease: Their quasi-organismal nature and dialogue with the host. Periodontol 2000. 2021;86(1):210-230. doi: 10.1111/prd.12371. Epub 2021 Mar 10. PMID: 33690950; PMCID: PMC8957750.
[29]. Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH, Flemmig TF, Garcia R, Giannobile WV, Graziani F, Greenwell H, Herrera D, Kao RT, Kebschull M, Kinane DF, Kirkwood KL, Kocher T, Kornman KS, Kumar PS, Loos BG, Machtei E, Meng H, Mombelli A, Needleman I, Offenbacher S, Seymour GJ, Teles R, Tonetti MS. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89 Suppl 1:S173-S182. doi: 10.1002/JPER.17-0721. PMID: 29926951.
Published
2022-10-31
How to Cite
NAVARRETE, Mariely et al.
Effect of Periodontal Debridement plus Systemic Azithromycin in subjects with Stage III Periodontitis: A Randomized Controlled Clinical Trial..
Journal of Oral Research, [S.l.], v. 11, n. 5, p. 1-16, oct. 2022.
ISSN 0719-2479.
Available at: <https://www.joralres.com/index.php/JOralRes/article/view/joralres.2022.051>. Date accessed: 26 apr. 2024.
doi: https://doi.org/10.17126/joralres.2022.051.
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