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Nonsurgical therapy of chronic periodontitis with adjunctive systemic azithromycin or amoxicillin/metronidazole

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Abstract

Objectives

The objective of the present study is to compare the effect of systemic adjunctive use of azithromycin with amoxicillin/metronidazole to scaling and root planing (SRP) in a clinical study.

Materials and methods

Data from 60 individuals with chronic periodontitis were evaluated after full-mouth SRP. Antibiotics were given from the first day of SRP, in the test group (n = 29), azithromycin for 3 days and, in the control group (n = 31), amoxicillin/metronidazole for7 days. Probing depth (PD), attachment level (AL), and bleeding on probing (BOP) were recorded at baseline and after 3 and 12 months. Gingival crevicular fluid was analyzed for matrix metalloprotease (MMP)-8 and interleukin (IL)-1beta levels. Subgingival plaque was taken for assessment of the major bacteria associated with periodontitis.

Results

In both groups, PD, AL, and BOP were significantly reduced (p < 0.001).

A few significant differences between the groups were found; AL and BOP were significantly better in the test than in the control group at the end of the study (p = 0.020 and 0.009). Periodontopathogens were reduced most in the test group.

Conclusions

A noninferiority of the treatment with azithromycin in comparison with amoxicillin/metronidazole can be stated. The administration of azithromycin could be an alternative to the use of amoxicillin/metronidazole adjunctive to SRP in patients with moderate or severe chronic periodontitis; however, a randomized placebo-controlled multicenter study is needed.

Clinical relevance

Application of azithromycin as a single antibiotic for 3 days might be considered as an additional adjunctive antibiotic to SRP in selected patients.

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Acknowledgments

The authors appreciate the laboratory work of Stéphanie Larti, Anna Magdon, and Marianne Weibel. They are grateful to Timothy Jones (Institute of Applied Linguistics and Translatology, University of Leipzig) for proofreading and to Walter B. Bürgin, Dipl. Biomed. Ing. (University of Bern), for statistical support.

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Author notes

    Authors and Affiliations

    1. Centre for Periodontology, Department of Cariology, Endodontology and Periodontology, University Hospital of Leipzig, Liebigstr. 12, Haus 1, 04103, Leipzig, Germany

      Holger F. R. Jentsch

    2. Private dental practice, Weiskirchen, Germany

      Andreas Buchmann & Abel Friedrich

    3. Department of Periodontology, Laboratory of Oral Microbiology, School of Dental Medicine, University of Bern, Bern, Switzerland

      Sigrun Eick

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    1. Holger F. R. Jentsch
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    2. Andreas Buchmann
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    Correspondence to Holger F. R. Jentsch.

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    Conflict of interest

    The authors (Holger Jentsch, Andreas Buchmann, Abel Friedrich, and Sigrun Eick) declare that they have no conflict of interest.

    Funding

    The study was funded by the participating institutions and partly supported by Hain Diagnostica, Nehren, Germany, who provided the materials for microbiological laboratory analyses.

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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    Informed consent was obtained from all individual participants included in the study.

    Additional information

    Holger F. R. Jentsch and Andreas Buchmann contributed equally to this work.

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    Jentsch, H.F.R., Buchmann, A., Friedrich, A. et al. Nonsurgical therapy of chronic periodontitis with adjunctive systemic azithromycin or amoxicillin/metronidazole. Clin Oral Invest 20, 1765–1773 (2016). https://doi.org/10.1007/s00784-015-1683-1

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    • DOI: https://doi.org/10.1007/s00784-015-1683-1

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