阿奇霉素辅助Ⅲ/Ⅳ期牙周炎患者非手术治疗的临床疗效及其对唾液微生物群落的影响

doi:10.13591/j.cnki.kqyx.2022.07.007

Abstract

Abstract: Objective To evaluate the clinical and microbiological effects of systemic azithromycin (AZI) as an adjunct to scaling and root planing (SRP) in the treatment of stage Ⅲ/Ⅳ periodontitis. Methods Forty patients were randomized into SRP group and AZI group. Clinical examinations and saliva collection were performed at baseline, 3 days and 6 weeks after SRP. Clinical examinations analyzed the treatment effects. Salivary microbiomes were analyzed through 16S rRNA sequencing, and the differences in richness, diversity, and relative abundance of each taxon were determined. Results All the clinical parameters were significantly improved after treatment in both groups compared to baseline(P<0.001). Greater clinical attachment loss(CAL)and bleeding on probing (BOP) improvements were found in the AZI group at 3 days and 6 weeks after treatment (P<0.05); improvement in probing depth (PD)was only found at the 6^th week(P<0.05). Results of site-level stratified statistics showed that periodontal indexes at the site level in the AZI group after treatment were better than those in the SRP group. All the alpha diversity indices were significantly reduced after treatment in the AZI group(P<0.05), while in SRP group, only Sobs index had a transient reduction 3 days after treatment. The proportion of Lactobacillus microbiota increased in both groups post-SRP, and was higher in the AZI group. Besides, the proportion of Treponema, and Fusobacterium decreased significantly in AZI group (P<0.05); at 3 days after treatment, the proportion of Porphyromonas decreased significantly (P<0.05), while the proportion of Prevotella increased significantly (P<0.05). However, at 6 weeks after treatment, the proportion of both regressed close to the baseline level (P>0.05). Conclusion AZI combined with non-surgical periodontal therapy, can improve clinical outcomes of severe periodontitis, change flora composition, and inhibit Treponema, Fusobacterium and Porphyromonas in periodontal red and orange pathogenic complexes.

Key words: azithromycin, scaling and root planing, periodontitis, 16S rRNA sequencing

CLC Number:

R781.4

YANG Ruoqu, HUO Pengcheng, HU Congjiao, SHI Mingyan, LUO Lijun. Microbiological and clinical effects of adjunctive azithromycin on non-surgical periodontal therapy of patients with stage Ⅲ/Ⅳ periodontitis[J]. Stomatology, 2022, 42(7): 609-616.

References

[1] Slots J. Primer on etiology and treatment of progressive/severe periodontitis: A systemic health perspective[J].Periodontol 2000, 2020, 83(1):272-276.
[2] 束蓉, 倪靖. 2018牙周病和植体周病国际新分类: 牙周炎分期分级疾病定义系统临床应用体会[J]. 口腔医学, 2020, 40(1):1-6.
[3] Mombelli A. Microbial colonization of the periodontal pocket and its significance for periodontal therapy[J].Periodontol 2000, 2018, 76(1):85-96.
[4] Chambrone L, Wang HL, Romanos GE. Antimicrobial photodyna-mic therapy for the treatment of periodontitis and peri-implantitis: An American Academy of Periodontology best evidence review[J]. J Periodontol, 2018, 89(7):783-803.
[5] Caton JG, Armitage G, Berglundh T, et al. A new classification scheme for periodontal and peri-implant diseases and conditions-Introduction and key changes from the 1999 classification[J]. J Clin Periodontol, 2018, 45(Suppl 20):S1-S8.
[6] Wolff D, Frese C, Schoilew K, et al. Amplicon-based microbiome study highlights the loss of diversity and the establishment of a set of species in patients with dentin caries[J]. PLoS One, 2019, 14(7):e0219714.
[7] Topcuoglu N, Kulekci G. 16S rRNA based microarray analysis of ten periodontal bacteria in patients with different forms of periodontitis[J]. Anaerobe, 2015, 35(Pt A):35-40.
[8] Pradeep AR, Kathariya R. Clarithromycin, as an adjunct to non surgical periodontal therapy for chronic periodontitis: A double blinded, placebo controlled, randomized clinical trial[J]. Arch Oral Biol, 2011, 56(10):1112-1119.
[9] Hagenfeld D, Koch R, Jünemann S, et al. Do we treat our patients or rather periodontal microbes with adjunctive antibiotics in periodontal therapy? A 16S rDNA microbial community analysis[J]. PLoS One, 2018, 13(4):e0195534.
[10] Dilber E, Hagenfeld D, Ehmke B, et al. A systematic review on bacterial community changes after periodontal therapy with and without systemic antibiotics: An analysis with a wider lens[J]. J Periodontal Res, 2020, 55(6):785-800.
[11] Zafar M, Jahan H, Shafeeq S,et al. Clarithromycin exerts an antibiofilm effect against Salmonella enterica serovar typhimuriumr darbiofilm formation and transforms the physiology towards an apparent oxygen-depleted energy and carbon metabolism[J]. Infect Immun, 2020, 88(11):e00510-e00520.
[12] Parnham MJ,Erakovic Haber V, Giamarellos-Bourboulis EJ, et al. Azithromycin: mechanisms of action and their relevance for clinical applications[J]. Pharmacol Ther, 2014, 143(2):225-245.
[13] Tamura A, Ara T, Imamura Y,et al. The effects of antibiotics on in vitro biofilm model of periodontal disease[J]. Eur J Med Res, 2008, 13(9):439-445.
[14] Kumar M, Rao M, Mathur T,et al. Azithromycin exhibits activity against Pseudomonas aeruginosa in chronic rat lung infection model[J]. Front Microbiol, 2021, 12: 603151.
[15] Kaufmann ME, Lenherr P, Walter C, et al. Systemically administered amoxicillin/metronidazole versus azithromycin as adjuncts to subgingival instrumentation during non-surgical periodontal therapy. A systematic review[J]. Swiss Dent J, 2020, 130(7/8):572-583.
[16] Liaw A, Miller C, Nimmo A. Comparing the periodontal tissue response to non-surgical scaling and root planing alone, adjunctive azithromycin, or adjunctive amoxicillin plus metronidazole in generalized chronic moderate-to-severe periodontitis: A preliminary randomized controlled trial[J]. Aust Dent J, 2019, 64(2):145-152.
[17] Latif SA, Vandana KL, Thimmashetty J, et al. Azithromycin buccal patch in treatment of chronic periodontitis[J]. Indian J Pharmacol, 2016, 48(2):208-213.
[18] Zhang Z, Zheng Y, Bian X. Clinical effect of azithromycin as an adjunct to non-surgical treatment of chronic periodontitis:A meta-analysis of randomized controlled clinical trials[J]. J Periodontal Res, 2016, 51(3):275-283.
[19] Nakajima T, Okui T, Ito H,et al. Microbiological and clinical effects of sitafloxacin and azithromycin in periodontitis patients receiving supportive periodontal therapy[J]. Antimicrob Agents Chemother, 2016, 60(3):1779-1787.
[20] Ozsvari B, Nuttall JR, Sotgia F, et al. Azithromycin and Roxithromycin define a new family of “senolytic” drugs that target senescent human fibroblasts[J]. Aging, 2018, 10(11):3294-3307.
[21] Khattri S, Kumbargere Nagraj S, Arora A,et al. Adjunctive systemic antimicrobials for the non-surgical treatment of periodontitis[J]. Cochrane Database Syst Rev, 2020, 11: CD012568.
[22] Povšič K, Čuk K, Milavec S, et al. Systemic azithromycin as an adjunct to scaling and root planing in patients with stage Ⅲ/Ⅳ periodontitis: 12-month results of a randomized controlled clinical trial[J]. Clin Oral Investig, 2021, 25(10):5997-6006.
[23] Morales A, Contador R, Bravo J,et al. Clinical effects of probiotic or azithromycin as an adjunct to scaling and root planning in the treatment of stage Ⅲ periodontitis: A pilot randomized controlled clinical trial[J]. BMC Oral Health, 2021, 21(1):12.
[24] Jagannathan N, Acharya A, Yi Farn O, et al. Disease severity, debridement approach and timing of drug modify outcomes of adjunctive azithromycin in non-surgical management of chronic periodontitis: A multivariate meta-analysis[J]. BMC Oral Heal, 2019, 19(1):65.
[25] O′Rourke VJ. Azithromycin as an adjunct to non-surgical periodontal therapy: A systematic review[J]. Aust Dent J, 2017, 62(1):14-22.
[26] Saleh A, Rincon J, Tan A, et al. Comparison of adjunctive azithromycin and amoxicillin/metronidazole for patients with chronic periodontitis: Preliminary randomized control trial[J]. Aust Dent J, 2016, 61(4):469-481.
[27] Caselli E, Fabbri C, D′Accolti M, et al. Defining the oral microbiome by whole-genome sequencing and resistome analysis: The complexity of the healthy picture[J]. BMC Microbiol, 2020, 20(1):120.
[28] Pirih FQ, Monajemzadeh S, Singh N, et al. Association between metabolic syndrome and periodontitis: The role of lipids, inflammatory cytokines, altered host response, and the microbiome[J]. Periodontol 2000, 2021, 87(1):50-75.
[29] Takeshita T, Nakano Y, Kumagai T, et al. The ecological proportion of indigenous bacterial populations in saliva is correlated with oral health status[J]. ISME J, 2009, 3(1):65-78.
[30] Haririan H, Andrukhov O, Bertl K,et al. Microbial analysis of subgingival plaque samples compared to that of whole saliva in patients with periodontitis[J]. J Periodontol, 2014, 85(6):819-828.
[31] Belstrøm D, Sembler-Møller ML, Grande MA, et al. Microbial profile comparisons of saliva, pooled and site-specific subgingival samples in periodontitis patients[J]. PLoS One, 2017, 12(8):e0182992.

Microbiological and clinical effects of adjunctive azithromycin on non-surgical periodontal therapy of patients with stage Ⅲ/Ⅳ periodontitis

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	ZHOU Huirong, LIN Xiaoping. Research advances in correlation between chronic periodontitis and prostatic diseases [J]. Stomatology, 2023, 43(3): 273-277.
[2]	XIE Yongmei, GE Huabing, FENG Jie, LIU Qi, ZHANG Ning, ZHONG Xiaoli. A short-term efficacy evaluation of biological antibacterial peptides in the adjuvant therapy of stageⅢ periodontitis [J]. Stomatology, 2023, 43(3): 237-241.
[3]	WANG Dexu, LUO Xiaojie, CHEN Xiaotao. Research progress of research on the effect of quorum-sensing system on periodontal pathogens [J]. Stomatology, 2023, 43(3): 267-272.
[4]	LEI Gang, WEI Xin, YAN Ming, ZHOU Lili, YU Jinhua, WANG Juan, WU Jintao. Clinical effects of iRoot BP plus and mineral trioxide aggregate in treatment of apical periodontitis with open apical permanent teeth [J]. Stomatology, 2023, 43(2): 118-124.
[5]	ZHANG Chaoying, GONG Jiaxing, YU Mengfei, QIAN Ying, ZHU Ziyu, LU Kejie, WANG Huiming. Application progress of alveolar ridge preservation in patients with tooth extracted due to periodontitis [J]. Stomatology, 2023, 43(2): 159-165.
[6]	SUN Yuezhang,WANG Qi. Morphological and immune characteristics of periodontal tissues under hyperglycemia [J]. Stomatology, 2023, 43(2): 153-158.
[7]	DAI Anna,DING Peihui. Periodontal therapy for stage Ⅳ grade C generalized periodontitis: A case report of 7-year follow-up [J]. Stomatology, 2023, 43(2): 145-152.
[8]	GENG Ying, MA Lu, FENG Zehua, WANG Xiaoqian, XU Yan, LI Lu. Evaluation of periodontal minimally invasive non-surgical therapy for the treatment of upper anterior teeth of patients with thin gingival phenotype [J]. Stomatology, 2022, 42(9): 807-812.
[9]	LIU Yuqing, GONG Yao, ZHAO Sufeng, DAI Li. Regulation effect of miR-155 on osteogenic differentiation of periodontal ligament stem cells in inflammatory microenvironment [J]. Stomatology, 2022, 42(9): 790-795.
[10]	ZHANG Shuting, WU Yaxing, LIU Cuicui, LI Chenchen, ZHANG Jing. Research progress of exosomes in osteogenic differentiation of bone marrow mesenchymal stem cells and in periodontal regeneration [J]. Stomatology, 2022, 42(8): 741-744.
[11]	LU Lijie, MIAO Lei, DENG Yu, PAN Yaping. Restoration of oral function by dental implantation combined with free gingival graft in a patient with distal-extension absence and periodontitis:A case report [J]. Stomatology, 2022, 42(8): 727-731.
[12]	YANG Zizhen, REN Xiuyun. Application of glycine air polishing in plaque control [J]. Stomatology, 2022, 42(7): 641-644.
[13]	DING Xu, LI Xin, LIU Xinchan, HOU Yubo, WU Zhou, YU Weixian. Role of mammalian target of rapamycin in renal injury associated with periodontitis in rats [J]. Stomatology, 2022, 42(5): 420-424.
[14]	SHEN Yue, ZHANG Yuan, CHEN Nianjie, HUANG Xinzhao, ZHONG Liangjun. Clinical and microbiological evaluation of Nd: YAP laser for adjuvant treatment of periodontitis [J]. Stomatology, 2022, 42(5): 446-450.
[15]	ZHAO Yuqi, TIAN Shenglan, LI Ying, WANG Aiqin. Research progress of activated matrix metalloproteinase-8 as a periodontal biomarker [J]. Stomatology, 2022, 42(4): 373-376.