Trial of metronidazole vs. azithromycin for treatment of cyclosporine-induced gingival overgrowth.
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.
Division of Pediatric Nephrology and Hypertension, The Children's Hospital at The Cleveland Clinic Foundation, A120 Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. chandd@ccf.org
Deepa H
DH
Chand
Joseph
J
Quattrocchi
Stacy A
SA
Poe
Geza T
GT
Terezhalmy
C Frederic
CF
Strife
Robert J
RJ
Cunningham
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D019214:Gingival Overgrowth / Q000139:chemically induced* / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D007166:Immunosuppressive Agents; D008795:Metronidazole; D017963:Azithromycin; D016572:Cyclosporine