Publication: Comparación de metronidazol y azitromicina como antimicrobianos sistémicos coadyuvantes en el tratamiento quirúrgico de la periodontitis asociada a P. gingivalis: un ensayo clínico aleatorizado
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2021
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Abstract
Objetivo: Determinar si el uso sistémico de azitromicina como tratamiento coadyuvante a la cirugía periodontal aporta beneficios clínicos y microbiológicos adicionales, respecto al uso sistémico de metronidazol en pacientes con periodontitis estadios III y IV positivos para Porphyromonas gingivalis (Pg).
Material y métodos: Se diseñó un ensayo clínico aleatorizado, paralelo y doble ciego con un seguimiento mínimo de 1 año, en el cual se comparó el uso de los antibióticos sistémicos metronidazol y azitromicina como tratamiento coadyuvante a la cirugía periodontal. Se evaluaron parámetros clínicos (cambios en la profundidad de sondaje (PS) y en el nivel de inserción clínica (NIC) y el porcentaje de localizaciones sin resolución clínica) y parámetros microbiológicos (frecuencia de detección de Pg y la proporción de Pg).
Resultados: Un total de 39 pacientes fueron aleatorizados, de los cuales 16 pacientes fueron asignados al grupo test (azitromicina) y 23 fueron asignados al grupo control (metronidazol). En las variables clínicas, a los 12 meses no hubo diferencias significativas entre los pacientes que recibieron metronidazol y los que recibieron azitromicina con respecto a los cambios en las profundidades de sondaje (2,26 ± 0,63 vs. 2,25 ± 1,03 respectivamente, p = 0,989), cambios en los niveles de inserción clínica (2,01 ± 0,50 vs. 1,91 ± 0,76, p = 0,714), ni con respecto al porcentaje de localizaciones sin resolución clínica (0,75 ± 0,90 vs. 1,60 ± 2,53, p = 0,261). En relación a las variables microbiológicas, a los 12 meses tampoco se observaron diferencias significativas entre ambos grupos con respecto a la frecuencia de detección de Pg (75% vs 54,55, p = 0,362, ni al porcentaje de Pg con relación al total de anaerobios (2,65 ± 0,3,5 vs 4,95 ± 6,73, p = 0,348).
Conclusiones: El tratamiento quirúrgico de la periodontitis estadios III y IV en pacientes Pg positivos obtuvo resultados clínicos favorables tanto con el uso de metronidazol como de azitromicina. Sin embargo, la erradicación del patógeno Pg resultó ser baja con el uso de ambos antibióticos sistémicos.
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