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24-03-2013 | Oral medicine | Article

Azithromycin shows promise for periodontitis in smokers


Free abstract

medwireNews: A single application of azithromycin results in improvements in clinical features of periodontitis, a study in smokers indicates.

The findings support further investigation of subgingival azithromycin as an adjunct to scaling and root planning in these difficult-to-treat patients, say the study authors writing in the Australian Dental Journal.

Avani Pradeep (Government Dental College and Research Institute, Bangalore, India) and colleagues undertook a randomized controlled trial in 54 people with chronic periodontitis. All were smokers, which is known to increase risk for periodontal disease and lessen the response to therapy.

All the patients were male and free of systemic disease but had moderately severe periodontal disease, defined as a pocket depth of at least 5 mm or clinical attachment level of 4-6 mm and vertical bone loss of at least 3 mm.

They were randomly assigned to receive either azithromycin 0.5% gel or placebo gel, delivered subgingivally by injection into periodontal pockets, following standard scaling and root planing.

There were no adverse reactions to azithromycin gel and no patient reported any discomfort, report the authors. All patients gave positive responses regarding the taste and flavor of the gel.

The primary efficacy endpoint was the change in clinical attachment level between baseline and 9 months. This parameter increased by 2.44 mm, on average, in the azithromycin group versus just 0.18 mm in the placebo group, indicating a statistically significant treatment effect.

A single application of azithromycin also offered significant improvements in plaque index, pocket depth, and bleeding at 9 months.

Noting that treating periodontal disease in smokers is often frustrating because of lack of response, the authors say that azithromycin has several potential advantages, including high tissue concentration, increased patient compliance, rapid wound healing, less short-term gingival inflammation, and sustained reduction of periopathogenic bacteria.

"Because of its high tissue concentration, tissue release is prolonged, leading to the delayed and gradual depletion of azithromycin," the authors remark.

They conclude: "This can provide a new direction in the field of periodontal treatment in this special group of patients who are at greater risk for periodontal destruction. However, long-term multicentre randomized, controlled clinical trials using different vehicles and concentrations of [azithromycin] should be carried out to confirm the observations of our study."

By Joanna Lyford, Senior medwireNews Reporter