Azithromycin in Periodontal Treatment

The macrolide antibiotic azithromycin is widely used extensively in medicine for the treatment of a wide range of infections including those of the upper respiratory tract and middle ear, sexually transmitted infections, and trachoma. It is also effective against the most common periodontopathogens. In addition to the antibiotic properties of the macrolides, these versatile drugs possess well-documented immune-modulating/anti-inflammatory effects. Macrolides, including azithromycin, are therefore used to treat diseases not associated with bacteria, such as severe asthma, chronic obstructive pulmonary diseases and, more recently, cystic fibrosis. Azithromycin is concentrated in neutrophils, macrophages and particularly fibroblasts, and all of these cells are central players in the pathogenesis of most periodontal diseases. A paper by Dr. Robert Hirsch et al, published in the Journal of Periodontal Research, reviews the diverse properties of azithromycin and the clinical periodontal studies of its effects in both the treatment of periodontitis and in resolving drug-related gingival overgrowth. The authors note that evidence supports the use of a single course of azithromycin in the treatment of advanced periodontal diseases. Azithromycin could have a triple role in the treatment and resolution of periodontal diseases: suppressing periodontopathogens, anti-inflammatory activity, and healing through persistence at low levels in macrophages and fibroblasts in periodontal tissues, even after a single course of 3 tablets. If future periodontal research confirms these properties, it could become a valuable host-modulator in periodontal treatment.
(Source: Journal of Periodontal Research. 2012, Volume 47, Issue 2, pages 137 to 148; doi: 10.1111/j.1600-0765.2011.01418.x)
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