From the Guidelines
Azithromycin is effective in treating periodontitis, particularly when used as an adjunct to standard periodontal therapy, with significant reductions in probing depth and clinical attachment level gain, as well as bleeding on probing, as shown in a recent study 1. The use of azithromycin in periodontitis treatment is supported by evidence of its beneficial effects on clinical outcomes, including probing depth, clinical attachment level, and bleeding on probing 1. Key benefits of azithromycin in periodontitis treatment include:
- Significant reduction in probing depth by 0.21 mm (95% CI, 0.12-0.29) 1
- Reduction in bleeding on probing by 4.50% (95% CI, 1.45-7.56) 1
- Increased attachment level by 0.23 mm (95% CI, 0.07-0.39) 1 It is essential to note that while azithromycin may be beneficial as an adjunct to standard periodontal therapy, mechanical debridement through professional dental cleaning remains the cornerstone of periodontitis treatment. Potential side effects of azithromycin, such as gastrointestinal disturbances, and concerns about contributing to antibiotic resistance with widespread use, should be considered when deciding on treatment 1. Overall, azithromycin can be a valuable addition to periodontitis treatment, particularly in cases where standard therapy is not sufficient, but its use should be judicious and based on individual patient needs 1.
From the Research
Effectiveness of Azithromycin in Treating Periodontitis
- Azithromycin has been shown to be effective in reducing probing depth and increasing periodontal attachment when used as an adjuvant treatment for chronic periodontitis 2.
- The antibiotic has a long half-life in periodontal tissues and is effective against Gram-negative aerobic and anaerobic bacteria, making it a suitable option for treating periodontitis 2, 3.
- Studies have demonstrated that azithromycin significantly reduces the presence of black pigmented anaerobes and spirochaetes, which are commonly implicated pathogens in periodontal disease 3, 4.
Comparison with Other Antibiotics
- Azithromycin has been compared to amoxicillin/metronidazole in the treatment of chronic periodontitis, with results showing that azithromycin may be a suitable alternative due to its shorter treatment duration and similar clinical outcomes 4, 5.
- However, one study found that adjunctive azithromycin therapy provided no additional benefit over nonsurgical periodontal treatment in patients with generalized aggressive periodontitis 6.
Microbiological Parameters
- Azithromycin has been shown to reduce the presence of periodontopathogens, including Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythia 3, 6.
- The antibiotic has also been found to decrease gingival crevicular fluid biomarkers, such as MMP-8 and IL-1beta, which are associated with periodontal inflammation 4, 6.
Clinical Implications
- Azithromycin may be considered as an adjunctive treatment to scaling and root planing in patients with moderate or severe chronic periodontitis, particularly in cases where other antibiotics are not suitable 2, 4, 5.
- However, further clinical trials are necessary to confirm the efficacy and safety of azithromycin in the treatment of periodontitis 5.