Efficacy of AZM therapy in patients with gingival overgrowth induced by Cyclosporine A: A systematic review

Epidemiology and Biostatistics Unit, Institute of Hygiene, Faculty of Medicine, Catholic University of the Sacred Heart-Rome, Italy.
BMC Oral Health (Impact Factor: 1.13). 01/2009; 8(1):34. DOI: 10.1186/1472-6831-8-34
Source: PubMed


In daily clinical practice of a dental department it's common to find gingival overgrowth (GO) in periodontal patients under treatment with Cyclosporine A (CsA). The pathogenesis of GO and the mechanism of action of Azithromycin (AZM) are unclear. A systematic review was conducted in order to evaluate the efficacy of Azithromycin in patients with gingival overgrowth induced by assumption of Cyclosporine A.
A bibliographic search was performed using the online databases MEDLINE, EMBASE and Cochrane Central of Register Controlled Trials (CENTRAL) in the time period between 1966 and September 2008.
The literature search retrieved 24 articles; only 5 were Randomised Controlled Trials (RCTs), published in English, fulfilled the inclusion criteria. A great heterogeneity between proposed treatments and outcomes was found, and this did not allow to conduct a quantitative meta-analysis. The systematic review revealed that a 5-day course of Azithromycin with Scaling and Root Planing reduces the degree of gingival overgrowth, while a 7-day course of metronidazole is only effective on concomitant bacterial over-infection.
Few RCTs on the efficacy of systemic antibiotic therapy in case of GO were found in the literature review. A systemic antibiotic therapy without plaque and calculus removal is not able to reduce gingival overgrowth. The great heterogeneity of diagnostic data and outcomes is due to the lack of precise diagnostic methods and protocols about GO. Future studies need to improve both diagnostic methods and tools and adequate classification aimed to determine a correct prognosis and an appropriate therapy for gingival overgrowth.

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    • "Drug-induced gingival overgrowth (DIGO) is a common adverse and mainly cosmetic effect among patients who receive ciclosporin. The reported incidence of DIGO is 70% in immunosuppressed children and 25–30% in adults (Clementini et al, 2008, Dongari-Bagtzoglou, 2004) DIGO results possibly from the inactivation of matrix metalloproteinases (Hyland et al, 2003). Gingival overgrowth may also be attributed to the co-administration of calcium channel blockers, often used for the treatment of ciclosporin-induced hypertension (Spratt et al, 1999). "
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