Microbiological and Clinical Effects of Sitafloxacin and Azithromycin in Periodontitis Patients Receiving Supportive Periodontal Therapy

Abstract

Sitafloxacin (STFX) is a newly developed quinolone that has robust antimicrobial activity against periodontopathic bacteria. We previously reported that oral administration of STFX during supportive periodontal therapy was as effective as conventional mechanical debridement under local anesthesia microbiologically and clinically for 3 months. The aim of the present study was to examine the short-term and long-term microbiological and clinical effects of systemic STFX and azithromycin (AZM) on active periodontal pockets during supportive periodontal therapy. Fifty-one patients receiving supportive periodontal therapy were randomly allocated to the STFX group (200 mg/day of STFX for 5 days) or the AZM group (500 mg/day of AZM for 3 days). The microbiological and clinical parameters were examined until 12 months after the systemic administration of each drug. The concentration of each drug in periodontal pockets and the antimicrobial susceptibility of clinical isolates were also analyzed. The proportions of red complex bacteria, i.e., Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, which are the representative periodontopathic bacteria, were significantly reduced at 1 month and remained lower at 12 months than those at baseline in both the STFX and AZM groups. Clinical parameters were significantly improved over the 12-month period in both groups. An increase in the MIC of AZM against clinical isolates was observed in the AZM group. These results indicate that monotherapy with systemic STFX and AZM might be an alternative treatment during supportive periodontal therapy in patients for whom invasive mechanical treatment is inappropriate. (This study has been registered with the University Hospital Medical Information Network-Clinical Trials Registry [UMIN-CTR] under registration number UMIN000007834.).

FIG 1

Flow diagram showing the progress of the study.

FIG 2

Median changes in total bacterial counts (A) and proportions of each periodontopathic bacterium (B) and numbers and percentages of red complex bacteria (RCB) in all sampling sites (C) and those of sampling sites with >5% RCB proportions at baseline (D) through the 1-month (1M) experimental period. The bars indicate the upper and lower interquartile ranges. The error bars indicate the 90th and 10th percentile ranges. The dots indicate the maximum and minimum values. The significance of differences within groups was determined by the Wilcoxon signed-rank test: *, P < 0.05.

FIG 3

Median changes in total bacterial counts (A) and proportions of each periodontopathic bacterium (B) and numbers and percentages of red complex bacteria (RCB) (C) through the 12-month period. Error bars indicate the upper and lower interquartile ranges. The significance of differences compared to baseline was determined by the Friedman test with Dunn's multiple-comparison test: *, P < 0.05; **, P < 0.01.