Adjunctive azithromycin in the treatment of aggressive periodontitis: microbiological findings of a 12-month randomized clinical trial

Objectives

To compare the subgingival microbiological outcomes of azithromycin or placebo as adjuncts to scaling and root planing (SRP) in the treatment of aggressive periodontitis (AgP), and to secondarily evaluate the microbiological effect of supragingival scaling in AgP patients.

Methods

Twenty-four AgP subjects 13–26 years of age received a 15-day programme of supragingival scaling (SC) and were then randomly assigned to SRP with systemic azithromycin or placebo. Subgingival samples were taken with sterile paper points at baseline, 15 days after SC, and at 3, 6 and 12 months following SRP. Microbiological analysis was performed by the checkerboard DNA–DNA hybridization.

Results

Changes in bacterial levels from baseline to 15 days after SC were similar in the 2 groups. When subjects were analysed as a single group, significant reductions after SC were observed for Actinomyces gerencseriae, Capnocytophaga ochracea, and Treponema denticola. During the 12-month follow-up, levels of most of the bacteria decreased in both groups in a similar pattern. For instance, Actinomyces israelli, Veillonella parvula, Streptococcus gordonii, C. ochracea, Eikenella corrodens, Eubacterium nodatum, Fusobacterium periodonticum and Fusobacterium nucleatum ssp. polymorphum decreased significantly within the groups.

Conclusions

Azithromycin was ineffective in lowering the subgingival levels of important putative periodontal pathogens in young AgP subjects compared to placebo.

Clinical significance

Scaling and root planing with adjunctive systemic azithromycin provides little additional benefit compared to placebo in reductions of major subgingival periodontal pathogens.     

Parkinson’s disease multimodal complex treatment improves gait performance: an exploratory wearable digital device-supported study

Journal of Neurology - Wearable device-based parameters (DBP) objectively describe gait and balance impairment in Parkinson’s disease (PD). We sought to investigate correlations between DBP...     

Microscopic qualitative evaluation of fixation time and decalcification media in rat maxillary periodontium

The rat model is widely used in periodontal research and the quality of histological sections is essential. The purpose of this study was to evaluate the histological characteristics of periodontal tissues in Wistar rat maxillae, with different times of fixation and decalcified by nitric acid or formic acid (Anna Morse Solution). Fifteen rats were used. Fixation was performed for 24, 48 and 72 hours. The maxillae were hemi-sectioned and each part was decalcified either in nitric acid for 7 days or in Anna Morse solution for 35 days. Two trained and blinded examiners performed the evaluation. Fourty eight hours of fixation and decalcification with Anna Morse solution showed more clear characteristics of the epithelium-connective tissue interface and of the periodontal structures. Mean measurements between the cementum-enamel junction and the bone crest varied in the different experimental times from 176.5 (+/- 60.45) to 210.94 (+/- 39.33) pixels on the buccal aspect, and from 199.69 (+/- 38.33) to 298.55 (+/-70.81) pixels on the palatal aspect, with no statistically significant differences (ANOVA, p > 0.05). In the same fixation period, decalcification with nitric acid or Anna Morse solution did not display any statistically significant differences. It may be concluded that for a qualitative histological analysis, fixation should preferably be for 48 hours and the demineralization should be made by Anna Morse solution. For a histomorphometric analysis, the decalcification solution does not interfere in the results.     

Comparative analysis between hard- and soft-filament toothbrushes related to plaque removal and gingival abrasion

OBJECTIVE: The aim of this split-mouth, examiner-blind study was to compare the dental plaque removal and incidence of gingival abrasion associated with the use of hard- and soft-filament toothbrushes. METHODOLOGY: The test group consisted of 20 non-dental students, mean age 25 years. After a three-day period of plaque accumulation following the use of a disclosing solution, the Quigley-Hein Plaque Index was recorded, while the presence of gingival abrasion was measured from photographs. Pairs of quadrants 1-3 and 2-4 were allocated to supervised brushing with hard- or soft-filament toothbrushes for 30 seconds, limited to the buccal aspects of the teeth. Plaque levels and gingival abrasion were again assessed. Initial and final values of the plaque index and the mean number of abrasions were compared with the Friedman and Wilcoxon tests (p < or = 0.05). RESULTS: Plaque indices were reduced significantly from a baseline of 4.12 in both groups to 1.21 after the use of hard-filament toothbrushes, and to 1.67 after the use of soft-filament toothbrushes. The use of hard-filament toothbrushes resulted in a significantly higher mean number of lesions when compared to the soft-filament toothbrushes; 11.6 and 7.9, respectively (p = 0.018). CONCLUSION: Hard-filament toothbrushes remove more plaque than soft filament brushes, but also cause a higher number of gingival abrasions.     

Clinical significance of anti-dsDNA antibody isotypes: IgG/IgM ratio of anti-dsDNA antibodies as a prognostic marker for lupus nephritis

The objective of this paper is to investigate the association between patterns of anti-dsDNA antibody isotypes and specific clinical manifestations (categorized in renal, musculoskeletal, cutaneous, hematological, pulmonary, neurological and cardiac). Sera of 202 systemic lupus erythematosus (SLE) patients, 33 patients suffering from other autoimmune diseases and 115 healthy blood donors were analysed for anti-dsDNA antibodies by IgG-, IgA- and IgM-specific ELISA, Farr-assay and CLIF. A subset of 24 SLE patients was investigated in a longitudinal study over a period of one to six years. Disease activity of 105 SLE patients was measured according to the ECLAM score. In the cohort of SLE patients 63% were positive for the IgG class, 40% for the IgA and 57% for the IgM class specific anti-dsDNA ELISA. Sensitivity (79%) and specificity (99%) for the diagnosis of SLE appeared to be highest for the ELISA measuring all isotypes of anti-dsDNA antibodies. The concentrations of anti-dsDNA isotypes showed a strong correlation with disease activity. Analysing the relationship between IgG, IgA and IgM anti-dsDNA antibody isotypes and clinical manifestation, we found a significant association of the IgM isotype with cutaneous involvement and of the IgG isotype with lupus nephritis. The IgG/IgM ratio of anti-dsDNA antibodies represented a significant parameter to distinguish patients with lupus nephritis from those without renal involvement. In the longitudinal study, a continuous ratio under 0.8 was associated with absence of renal involvement throughout the investigated period. In conclusion, the evaluation of anti-dsDNA isotypes provides a diagnostic tool to define subsets within SLE patients with different clinical manifestations. In particular, the IgG/IgM ratio of anti-dsDNA antibodies could be used as a prognostic marker for lupus nephritis during the course of the disease.     

Clinical efficacy and safety of teicoplanin in the treatment of gram-positive infections

Summary This study was an open efficacy and safety study of teicoplanin in hospitalized patients with gram-positive infections. 26 patients entered the study. Teicoplanin was administered by intravenous bolus injection at a dose of 200 mg or 400 mg every 24 h, and in all cases an initial loading dose of 400 mg was given. The mean duration of treatment was 9.4 days (range four to 20 days). The infections included 18 skin/soft tissue, four lower respiratory tract, two urinary tract and two joint/bone. Clinical cure and improvement occurred in 20 of the 26 patients. Only two adverse events (moderate diarrhoea and mild pain at injection site) related to teicoplanin occurred in one patient. It was concluded that teicoplanin was effective and well tolerated in the treatment of gram-positive infections.

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Klinische Wirksamkeit und Verträglichkeit von Teicoplanin in der Behandlung von grampositiven Infektionen

Zusammenfassung In einer offenen Studie wurde die klinische Wirksamkeit und Verträglichkeit von Teicoplanin bei 26 Patienten mit grampositiven Infektionen geprüft. Teicoplanin wurde mittels i.v. Bolusinjektion in der Dosierung von 200 mg oder 400 mg alle 24 Stunden verabreicht. In allen Fällen wurde eine Initialdosis von 400 mg gegeben. Die durchschnittliche Behandlungsdauer betrug 9,4 Tage (4–20 Tage). Folgende Infektionen wurden behandelt: 18 Haut/Weichteile, vier untere Atenwege, zwei Harnwege und zwei Knochen/Gelenke. Eine klinische Heilungs- und Besserungsrate wurde bei 20 der 26 Patienten erzielt. Nur zwei unerwünschte Arzneimittelwirkungen (mäßige Diarrhoe und leichter Schmerz an der Injektionsstelle) wurden bei einem Patienten beobachtet. Die Ergebnisse lassen darauf schließen, daß Teicoplanin in der Behandlung von grampositiven Infektionen wirksam und gut verträglich ist.

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Supported by Merrell Dow Pharma GmbH, Rüsselsheim, FR Germany.