In this month’s issue of General Dentistry, there is an article highlighting the use of azithromycin in periodontal therapy. I have never used a lot of antimicrobial therapies in my periodontal patients. Every once in a while I will prescribe 100mg of doxycycline to patient after scaling and root planing, but to be honest I could not give a reason as to why I would or would not on any particular patient. I have never really looked at any of the data on the low-dose antibiotics like 20mg of doxycycline daily for perio maintenance patients. For my practice, I really need to see a significant difference to justify adding another step into my patient’s routine. Compliance is a major issue with all patients, whether you think it is or not.
This study took 100 patients with moderate to advanced periodontitis and treated them with scaling and root planing plus three courses of azithromycin during the hygiene phase. The patients were re-evaluated and necessary surgeries and or extractions were performed (32 patients needed this extra treatment). All were then put on maintenance with four month recall visits. Clinical parameters were recorded at baseline, six weeks after hygiene phase, and 96 & 192 weeks into maintenance. The results showed that probing depths, bleeding, and supparation were reduced significantly at re-evaluation.
One of the most interesting parts of this study is that this was not a double blind study. All patients received azithromycin. There was not a control group to compare the azithromycin groups results with. This is a prime example of how sometimes the fine print of a study must be ready to determine it’s value. Azithromycin may be the greatest periodontal adjunct treatment in the history of man kind, but this study does not prove that. This study does not prove anything actually. In my opinion, the only thing this study shows is that periodontal patients that receive non-surgical intervention followed by close evaluation, surgery when needed, and continuous maintenance have reduced probing depths, bleeding and supparation. Because azithromycin was not isolated as a variable, there is no worthwhile evidence for it’s use.
Sometimes you need to read the fine print on studies to determine their effectiveness. Based on this, I will not be administering azithromycin to my periodontal patients.