Elsevier

Transplantation Proceedings

Volume 36, Issue 9, November 2004, Pages 2699-2702
Transplantation Proceedings

Effects of azithromycin on cyclosporine-induced gingival hyperplasia in renal transplant patients

https://doi.org/10.1016/j.transproceed.2004.09.059Get rights and content

Abstract

Background

Gingival hyperplasia is a well-known complication of cyclosporine therapy, affecting 21% to 35% of renal transplant patients. Metronidazole, clarithromycin, and azithromycin, all azalid antimicrobial agents derived from the macrolide antibiotic erythromycin, have been used for treatment. Marked improvements in gingival hyperplasia have been recorded in particular with azithromycin. The aim of the present study was to investigate histopathological features of cyclosporine-induced gingival hyperplasia and to evaluate the quantitative efficacy of short-term azithromycin therapy.

Methods

Eighteen renal transplant patients with cyclosporine-induced gingival hyperplasia were included in the study. All patients received azithromycin with a dose of 500 mg/d for 3 consecutive days. Changes in gingival hyperplasia were evaluated by measuring the gingival sulcus depth to the cementum-enamel junction of every tooth in each of the four quadrants on days 0, 7, 30, 90, 180. Gum biopsies were obtained on days 0 and 30; the degree of inflammation was classified as “mild,” “intermediate,” and “severe”.

Results

Gingival hyperplasia was reduced in all treated patients throughout the study. The degree of improvement was more significant between 0 to 7 and 7 to 30 days than at other times (respectively, P < .0001 and P < .002). Histopathologically, eight patients had severe and one patient moderate chronic inflammation at the beginning of therapy. Three other biopsies were reported as papilloma, mucosal hyperplasia, and normal gingival tissue biopsy.

Conclusions

Azithromycin appears to be useful to treat cyclosporine-induced gingival hyperplasia in renal transplant patients. Treatment is inexpensive and free from known adverse effects.

Section snippets

Subjects and methods

Eighteen renal transplant patients with cyclosporine-induced gingival hyperplasia were included in the study between July 2000 and June 2001. Patients were excluded for: a follow-up less than 6 months; introduction of calcium-channel blockers therapy during the study (with exception if they were taking those drugs before entering the study); impaired renal function due to rejection; or patients who died due to any other cause during the study.

All patients received azithromycin for gingival

Results

At the beginning of the study 18 patients with gingival hyperplasia were examined. Six patients were excluded: two with serum creatinine greater than 2 mg/dL, two who did not return for visits, one who used calcium channel blockers after azithromycin treatment, and one who developed Hodgkin's disease and died due to septic shock. The mean age was 35 ± 8 (24 to 51) years and time from transplantation 2.7 ± 1.8 years. Detailed data on all patients including gingival bleeding, gingival surgery,

Discussion

There have been several reports about medical treatment of cyclosporine induced gingival hyperplasia especially with azithromycin.4, 5, 6, 7, 8, 9, 10 Azithromycin therapy for 3 to 5 days has been shown to improve gingival hyperplasia.5, 6, 7 Azithromycin is inexpensive. It may be used safely since it does not have remarkable side effects and does not affect levels of cyclosporine, creatinine, or ALT. A qualitative scoring system was used to monitor the degree of hyperplasia in previous reports.

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