Azithromycin in periodontal treatment: more than an antibiotic

Abstract

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.

Microbiological and Clinical Effects of Sitafloxacin and Azithromycin in Periodontitis Patients Receiving Supportive Periodontal Therapy

“…Azithromycin (AZM), a macrolide antibiotic, is highly effective against a wide range of bacteria, including the common periodontopathic bacteria (15). A number of studies have supported the clinical and microbiological advantages of systemically administered AZM as an adjunct to scaling and root planing (16)(17)(18)(19)(20).…”

Treponema denticola: patógeno en procesos periodontales y pulpares

“…Su eliminación y control de procesos periodontales y endodonticos , se realiza por procedimientos de fase I Periodontal, así como, por tratamiento de conducto pudiendo sumarse a estos, en algunos casos, antibioticoterapia, como lo propuesto por Rodriguez 20 , en caso de GUN, dándole al paciente metronidazol mas amoxicilina por 8 días o en el caso de periodontitis severa Chiappe 21 propone dar espiramicina por 7 días, Hirsch 22 en su revisión del uso de azitromicina en el tratamiento periodontal, menciona el uso de este por vía oral en dosis de 500 mg x 3 días consecutivos.…”

“…5 Antibióticos de uso sistémico se pueden dar como; metronidazol 500mg cada 8 horas por 7 a 10 dias 20 , metronidazol 500mg mas amoxicilina 500 mg. Cada 8 horas por 8 a 10 días 5,20 , espiramicina 650 mg cada 12 horas x 7 días 21 , metronidazol 250 mg mas espiramicina 500 mg cada 8 horas 20 o azitromicina 500 mg c/ 24 horas x 3 días consecutivos. 22 El control clínico como microbiológico de los procesos debe realizarse periódi-camente, para identificar el incremento de este patógeno, si esto sucediera se estaría determinando un riesgo para la progresión de la enfermedad. Por tanto T. denticola, podría ser utilizado como un marcador biológico de la progresión de la enfermedad periodontal.…”

Changes in antimicrobial susceptibility profile and prevalence of quinolone low-sensitive strains in subgingival plaque from acute periodontal lesions after systemic administration of sitafloxacin

“…In recent years, azithromycin has been used as an adjunctive agent in the management of periodontitis [5]. While the use of azithromycin can be an effective adjunctive treatment modality, a concern has been raised regarding the increased incidence of bacterial resistance to macrolides including azithromycin [5,6].…”