One protocol for the use of adjunctive antibiotics in the treatment of advanced periodontal infections involves the prescription of amoxicillin (500mg) together with metronidazole (500mg) (Gareth et al J Clinical Periodontology 2011 38:43-49 Amoxicillin and metronidazole as an adjunctive treatment in generalized aggressive periodontitis at initial therapy or re-treatment: a randomized controlled clinical trial (pages 43–49).
Azithromycin has both antibiotic capabilities against periodontopathogens AND anti-inflammatory and immuno-modulating properties; neither amoxicillin, metronidazole nor the combination of the two, have the latter properties.
The following chart shows the antibiotic dosage of the two antibiotic regimens over the recommended course (3 days for azithromycin vs 7 days for amoxicillin and metronidazole).
As the dosage of azithromycin is approximately 12 times less than amoxicillin + metronidazole and the time patients are exposed to the antibiotic is significantly less (3 vs 7 days) it is my conjecture that the likelihood of bacterial resistance developing is much higher for the amoxicillin + metronidazole than the azithromycin regimen.
Furthermore, a significant number of people taking amoxicillin + metronidazole have side effects compared with azithromycin. Compliance is likely to be better with azithromycin (3 tablets vs 42 tablets of amoxicillin + metronidazole ) especially when side effects are common.
Given the efficacy of azithromycin in reducing the signs and symptoms of advanced periodontitis over a long period of time after a single course with a very low incidence of side effects, I can no longer justify using the sledgehammer of amoxicillin + metronidazole in my patients.
Thanks for the great information on Azithromycin and periodontal disease. Certainly it is a good alternative method of helping along with conventional periodontal treatment.
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