Clinical efficacy of subgingivally delivered 0.5% controlled release azithromycin gel in the management of chronic periodontitis

Abstract

Recent developments suggest that the local delivery of antimicrobials into periodontal pockets can improve periodontal health. Azithromycin (AZM) has a wide antimicrobial spectrum of action toward anaerobic bacteria as well as Gram-negative bacilli. It is effective against periodontal pathogens such as Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis. Therefore, this study was undertaken to investigate the clinical effectiveness of AZM at 0.5% concentration in an indigenously prepared bioabsorbable controlled release gel as an adjunct to non-surgical mechanical therapy in the treatment of chronic periodontitis. Thirty sites in patients with chronic periodontitis and probing depth (PD) 4-6 mm were categorized randomly into two treatment groups: Scaling and root planing (SRP) plus 0.5% AZM gel (group 1) and SRP only (group 2). Clinical evaluation was undertaken using the Gingival Index (GI) of Loe and Silness and plaque was assessed using the Turesky et al. modification of Quigley Hein Index at baseline and 21 days. Pocket PD and clinical attachment level (CAL) were also measured. Results were expressed as mean±standard deviation and percentages and the data were analyzed using Statistical Package for Social Sciences (SPSS version 16.0, SPSS, Chicago, IL) software. Both therapies resulted in significant improvements. Mean reduction in GI from baseline to 21 days was 1.20±0.41 and 0.73±0.45 in group 1 and group 2, respectively. Plaque Index also improved through the study period in both groups, i.e., 0.86±0.51 in group 1 and 1.6±0.97 in group 2. Mean PD reduced significantly with SRP plus AZM gel application in group 1, i.e., 2.1±0.91 mm as compared to 1.0±1.06 mm achieved with SRP alone. A significant gain in mean CAL gain was observed in the test group (1.8±0.63 mm) as compared to control group (1.0±1.06 mm). Although both treatment strategies seem to benefit patients, the adjunctive use of 0.5% of AZM showed significant results.