Adjunctive Use of Azithromycin to Non‐Surgical Periodontal Therapy: Rationale and Evidence for Its Use in Periodontitis—A Scoping Review

BACKGROUND: Antimicrobials are added as adjuncts to non-surgical periodontal therapy in certain cases to achieve improved outcomes. Among the adjunct antimicrobials that have gained renewed interest is azithromycin, owing to its additional anti-inflammatory and host-modulating properties. This review aims to summarise the pharmacology, adverse effects, and the current evidence for the adjunct use of azithromycin in different forms of periodontitis. METHODS: In vitro studies, randomized controlled trials, and longitudinal studies published in English were searched in MEDLINE, Scopus, Web of Science and Google Scholar (https://osf.io/m8enj/overview). Following screening of 677 articles, 70 articles were subjected to full-text review and ultimately 57 articles were included. RESULTS: In vitro studies demonstrated anti-bacterial, host-modulating, and anti-inflammatory properties of azithromycin with drug concentrating in inflamed tissues. The additional benefits of adjunctive azithromycin are moderate and inconsistent, although deep periodontal pockets may show enhanced improvements. Local delivery of azithromycin demonstrated additional benefits in single-rooted teeth. CONCLUSION: Azithromycin may provide clinical and microbiological benefits, especially in deep periodontal pockets. However, the World Health Organization categorizes azithromycin as a critically important antimicrobial for human medicine. Due to inconsistent results and owing to the importance of azithromycin, the adjunctive use of azithromycin with non-surgical periodontal therapy is currently not recommended.