Azithromycin as an adjunctive treatment of generalized severe chronic periodontitis: clinical, microbiologic, and biochemical parameters.
BACKGROUND
This study examines the efficacy of azithromycin in combination with non-surgical periodontal therapy on clinical and microbiologic parameters and gingival crevicular fluid (GCF) matrix metalloproteinases-8 (MMP-8) levels over 6 months in patients with severe generalized chronic periodontitis (CP).


METHODS
Twenty-eight of 36 patients with severe generalized CP were included in this randomized, double-masked, placebo-controlled, parallel-arm study. They were randomly assigned to azithromycin or placebo groups (500 mg, once daily for 3 days). Probing depth (PD), clinical attachment level, dichotomous presence or absence of supragingival plaque accumulation, and bleeding on probing were recorded. GCF samples were obtained from one single-rooted tooth with PD ≥ 6 mm, whereas microbiologic samples were collected from two single-rooted teeth with PD ≥ 6 mm. Microbiologic parameters were analyzed by quantitative real-time polymerase chain reaction for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium nucleatum, Prevotella intermedia, and total bacteria. GCF MMP-8 levels were determined by immunofluorescence assay.


RESULTS
Azithromycin and placebo groups demonstrated similar but significant improvements in all clinical parameters (P <0.05). A. actinomycetemcomitans, P. gingivalis, T. forsythia, P. intermedia, and total bacteria significantly decreased over the 6-month period in both groups, whereas F. nucleatum was significantly reduced in all visits in the azithromycin group, with the levels also being lower compared with those of the placebo group (P <0.05). The azithromycin and placebo groups exhibited significant reduction in GCF MMP-8 levels at the post-treatment visit and at 2 weeks (P <0.05).


CONCLUSIONS
On the basis of the present findings, it can be concluded that adjunctive azithromycin provides no additional benefit over non-surgical periodontal treatment on parameters investigated in patients with severe generalized CP.
Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey.
Buket
B
Han
Gülnur
G
Emingil
Güven
G
Özdemir
Taina
T
Tervahartiala
Caner
C
Vural
Gül
G
Atilla
Haluk
H
Baylas
Timo
T
Sorsa
D000328:Adult; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D055113:Chronic Periodontitis / Q000188:drug therapy* / Q000201:enzymology / Q000382:microbiology*; D004269:DNA, Bacterial / Q000235:genetics; D003773:Dental Plaque / Q000382:microbiology*; D012534:Dental Scaling; D004311:Double-Blind Method; D005260:Female; D005883:Gingival Crevicular Fluid / Q000201:enzymology*; D006801:Humans; D008297:Male; D020784:Matrix Metalloproteinase 8 / Q000032:analysis / Q000378:metabolism*; D008875:Middle Aged; D010512:Periodontal Index; D018709:Statistics, Nonparametric
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D017963:Azithromycin; D020784:Matrix Metalloproteinase 8