Comparison of Azithromycin and Amoxicillin Before Dental Implant Placement: An Exploratory Study of Bioavailability and Resolution of Postoperative Inflammation
Comparison of Azithromycin and Amoxicillin Before Dental Implant Placement: An Exploratory Study of Bioavailability and Resolution of Postoperative Inflammation
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DOI：
10.1902/jop.2015.150024
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发表时间：
2015-11-01
影响因子：
4.3
通讯作者：
Walters, John D.
中科院分区：
文献类型：
--
作者：
Escalante, Mariana Gil;Eubank, Tim D.;Walters, John D.
背景资料：研究表明，单次预防性剂量的阿莫西林可减少早期植入并发症，但尚不清楚其他抗生素是否也有效。本研究比较了局部抗菌和抗炎作用，从一个单一的剂量的阿奇霉素或阿莫西林手术前放置的一个阶段dental implants.Methods：健康的成年患者需要一个阶段的牙科种植体放置随机分配到接受2克阿莫西林（n = 7）或500毫克阿奇霉素（n = 6）手术前。在术后第6、13和20天对新种植体的种植体周围沟液（PICF）样本和邻牙的牙龈沟液（GCF）样本进行采样。通过免疫测定法分析样品中的炎症介质，并通过生物测定法测定抗生素水平。结果：在第6天，阿奇霉素在GCF和PICF中的浓度分别为3.39 +/- 0.73和2.77 +/- 0.90 mg/mL，而阿莫西林低于检测限。在早期愈合过程中，阿奇霉素组患者的GCF体积显著减少（P = 0.03，方差分析）。在愈合过程中的特定时间，阿奇霉素组GCF中的白细胞介素（IL）-6和IL-8水平显著低于阿莫西林组，PICF中的粒细胞集落刺激因子、IL-8、巨噬细胞炎性蛋白-1 β和干扰素-γ诱导蛋白-10水平显著低于阿莫西林组。阿奇霉素在手术部位的使用时间比阿莫西林长，服用阿奇霉素的患者在GCF和PICF中表现出较低水平的特异性促炎细胞因子和趋化因子。因此，术前阿奇霉素可能比阿莫西林更大程度地促进术后炎症的消退。
Background: Studies suggest that a single prophylactic dose of amoxicillin reduces early implant complications, but it is unclear whether other antibiotics are also effective. This study compared the local antimicrobial and anti-inflammatory effects resulting from a single dose of azithromycin or amoxicillin before surgical placement of one-stage dental implants.Methods: Healthy adult patients requiring one-stage dental implant placement were allocated randomly to receive either 2 g amoxicillin (n = 7) or 500 mg azithromycin (n = 6) before surgery. Peri-implant crevicular fluid (PICF) samples from the new implant and gingival crevicular fluid (GCF) from adjacent teeth were sampled on postoperative days 6, 13, and 20. Inflammatory mediators in the samples were analyzed by immunoassay, and antibiotic levels were measured by bioassay.Results: On day 6, azithromycin concentrations in GCF and PICF were 3.39 +/- 0.73 and 2.77 +/- 0.90 mg/mL, respectively, whereas amoxicillin was below the limit of detection. During early healing, patents in the azithromycin group exhibited a significantly greater decrease in GCF volume (P = 0.03, analysis of variance). At specific times during healing, the azithromycin group exhibited significantly lower levels of interleukin (IL)-6 and IL-8 in GCF than the amoxicillin group and exhibited significantly lower levels of granulocyte colony stimulating factor, IL-8, macrophage inflammatory protein-1 beta, and interferon-gamma-inducible protein-10 in PICF.Conclusions: Azithromycin was available at the surgical site for a longer period of time than amoxicillin, and patients taking azithromycin exhibited lower levels of specific proinflammatory cytokines and chemokines in GCF and PICF. Thus, preoperative azithromycin may enhance resolution of postoperative inflammation to a greater extent than amoxicillin.