Azithromycin and Periodontal Maintenance

Some patients who have had periodontal therapy (both conservative and surgical) and who attend for regular maintenance, struggle to keep their periodontal condition under control.  Their levels of gingival inflammation may be high, periodontal pockets persist or deepen and they may be loosing teeth along the way.  These cases have been described as 'downhill' or 'extreme downhill'.  Conventional re-treatment or maintenance does not seem to be able to stabilise their condition.

The use of a single course of azithromycin has, in my experience, turned cases such as these around .  Patients report rapid improvement in their periodontal symptoms and in the overall comfort of the teeth.  They express gratitude that, at last, they are making progress with their periodontal health.  Pocket depths significantly reduce after 6-8 weeks, there is much less bleeding on probing and the amount of blood arising during subsequent periodontal maintenance visits is minmal, as opposed to the copious bleeding that occurred previously during maintenance.  Intervals betweeen periodontal maintenance visits is usually extended from 2-3 monthly to 5-6 monthly for these cases.

Here are some extracts from my clinical notes of a patient I have been seeing since 1999 when she was 29.  She had aggressive generalised periodontitis and underwent extensive open flap debridement followed by periodontal maintenance over the years.  'June 2006: granulation tissue noted at the entrance of pockets, good OH but underlying gingival inflammation, deep pockets 16d, 14, 13, 12, 24 8mm.  Pockets debrided, review 2 months'.  And so it went until I prescribed a single course of azithromycin in December 2008.  Within 3 months, her periodontal situation had turned around, there were no pockets and no bleeding.  Recall intervals are now set at 6 months rather than 2-3 months.  It is now 2 years since she took the single course of azithromycin and her periodontal health has never been better (see image below). This person is very pleased with the outcome!

Clinical appearance 18 months after single course of azithromycin,
note the healthy quality of the gingival tissues