Oral metronidazole does not improve cyclosporine A-induced gingival hyperplasia

Abstract

Recently, resolution of cyclosporine A (CSA)-induced gingival hyperplasia was reported with antibiotic treatment. We therefore assessed the oral status of 45 children on CSA after renal transplantation and evaluated the effects of metronidazole treatment in children with high-grade gingival hyperplasia. Gingival hyperplasia was absent in 19 (42%), mild in 5 (11%), moderate in 13 (29%), and severe in 8 (18%) children. There was no significantly different incidence in high-grade gingival hyperplasia (moderate and severe) between children with (16 of 30) or without (5 of 15) concomitant treatment with calcium channel blockers. The mean trough level of CSA was not different between children with varying severities of gingival hyperplasia. We treated 13 children with high-grade CSA-induced gingival hyperplasia (9 boys, 4 girls, mean age 14.2 +/- 3.4 years) with 750 mg metronidazole in three divided doses (10-25 mg/kg) for a total of 7 days. All 13 children were concomitantly treated with calcium channel blockers for hypertension; their mean monoclonal CSA trough level was 246 +/- 34 ng/ml. Oral examination and photographic documentation were performed by the same examiner on all patients before and 1 and 3 months after metronidazole treatment. We found no changes in gingival hyperplasia; gingival inflammation improved in 5 children (P = ns). We conclude that synergistic effects of calcium channel blockers and high concentrations of CSA in our population may outweigh beneficial effects of metronidazole treatment of CSA-induced gingival hyperplasia after renal transplantation.

The management of drug‐induced gingival overgrowth

“…No details were provided of the patient's periodontal condition before medication with metronidazole and the small number of patients and lack of a control group somewhat limits the significance of these findings. Furthermore, in a larger study of 13 children, no improvement in overgrowth were seen at the end of a 3‐month period (Aufricht et al 1997). In addition, metronidazole is known to reduce the hepatic metabolism of ciclosporin leading to the potential risk of nephrotoxicity (Herzig & Johnson 1999).…”

Efficacy of azithromycin and metronidazole combined therapy on rats’ gingival overgrowth induced by cyclosporine-A: An experimental animal study

“…Long-term results, however, showed greater efficacy of mtz with respect to placebo in controlling CsAinduced GO. In contrary, Aufricht et al 26 concluded that oral metronidazole does not improve CsA-induced GO. Group VI revealed less pronounced GO (100% score 1) with knife edge, less collagenized connective tissue that covered with thin epithelial layers and flat basement membrane, moderate reaction to TGF-b, mild reaction to MMP-1, and a negative connective tissue reaction to IL-6.…”

Comparison of Azithromycin and Oral Hygiene Program in the Treatment of Cyclosporine-Induced Gingival Hyperplasia

“…[18,19] Moreover, the beneficial effect of azithromycin on GH was not clearly demonstrated with other antibiotics. Whereas Wong et al [20] were successful in controlling CSA-induced GH using metronidazole for seven days, Aufricht et al [21] did not obtain protection using a similar antibiotic schedule. A study testing the efficacy of metronidazole and azithromycin in controlling CSA-induced GH has shown that the latter was significantly more effective.…”