Comparison of Azithromycin and Amoxicillin Before Dental Implant Placement: An Exploratory Study of Bioavailability and Resolution of Postoperative Inflammation

Abstract

Background Studies suggest that a single prophylactic dose of amoxicillin reduces early implant complications, but it is unclear whether other antibiotics are also effective. This study compared the local antimicrobial and anti-inflammatory effects resulting from a single dose of azithromycin or amoxicillin prior to surgical placement of one-stage dental implants. Methods Healthy adult patients requiring one-stage dental implant placement were randomly allocated to receive either 2g amoxicillin (n=7) or 500mg azithromycin (n=6) prior to surgery. Peri-implant crevicular fluid (PICF) samples from the new implant and gingival crevicular fluid (GCF) from adjacent teeth were sampled on postoperative days 6, 13 and 20. Inflammatory mediators in the samples were analyzed by immunoassay and antibiotic levels were measured by bioassay. Results On day 6, azithromycin concentrations in GCF and PICF were 3.39±0.73μg/ml and 2.77±0.90μg/ml, respectively, while amoxicillin was below the limit of detection. During early healing, patents in the azithromycin group exhibited a significantly greater decrease in GCF volume (p=0.03, ANOVA). At specific times during healing, the azithromycin group exhibited significantly lower levels of IL-6 and IL-8 in GCF than the amoxicillin group and exhibited significantly lower levels of G-CSF, IL-8, MIP-1β and IP-10 in PICF. Conclusions Azithromycin was available at the surgical site for a longer period of time than amoxicillin, and patients taking azithromycin exhibited lower levels of specific pro-inflammatory cytokines and chemokines in GCF and PICF. Thus, preoperative azithromycin may enhance resolution of postoperative inflammation to a greater extent than amoxicillin.

Letters to the Editor: Re: Comparison of Azithromycin and Amoxicillin Before Dental Implant Placement: An Exploratory Study of Bioavailability and Resolution of Postoperative Inflammation

“…As suggested by Escalante et al, 1 the most remarkable finding of their study is that a single prophylactic dose of AZM appeared to alter several potentially important aspects of inflammation and early healing after implant surgery. This conclusion is very important and could affect the clinical behavior of dental clinicians.…”

“…We have read the paper by Escalante et al 1 with great interest. However, we have some concerns regarding the safety of prophylactic azithromycin (AZM) use in implant candidates.…”

Interpreting the Azithromycin Versus Amoxicillin Preoperative Surgical Prophylaxis Issue

“….''. 1 The study provides evidence that azithromycin (with its antimicrobial activity) was still present at the surgical site on postoperative day 6 and that proinflammatory cytokine and chemokine markers (G-CSF, IL-8, MIP-1b, and IP-10) in the periimplant crevicular fluid were significantly decreased. Both of these findings are not surprising when one considers the pharmaco-dynamics and -kinetics of azithromycin.…”

“…Recently the Journal of Periodontology published ''Comparison of azithromycin and amoxicillin prior to dental implant placement: an exploratory study of bioavailability and resolution of postoperative inflammation'' by Escalante et al 1 This paper has piqued the interest of implant clinicians. Several clinicians have mentioned that after reading this paper, they have concluded that all implant patients would be better served by the use of azithromycin versus amoxicillin as a single preoperative antibiotic surgical prophylaxis.…”

Evaluation of two amoxicillin protocols for antibiotic prophylaxis in implant placement surgeries

“…Likewise any other surgical procedure, during the installation of dental implants, contamination of the manipulated sites can occur reinforcing the importance of preventing infection of the surgical site. This prevention is performed mainly by the maintenance of the aseptic chain during the surgical procedure and also by the prophylactic use of antibiotics 2,[5][6][7] . Despite some studies have reported [8][9] the improvement of success rates using antibiotics in the preoperative period, their role in the implants placement as well as their effect on the failure or survival of these implants along with postoperative infection can still be a controversial practice.…”