Combined treatments with non-steroidal anti-inflammatory drugs and
antibiotics may offer significant benefits in the prevention of
pain and
infections associated with
oral surgery. In this study,
piroxicam and
azithromycin were administered to patients undergoing dental extraction to examine the efficacy of
piroxicam in the prevention of
post-operative pain and inflammatory complications, either in the absence or in the presence of a concomitant
antibiotic treatment. Thirty patients were randomly assigned to three groups and treated for 3 days, before impacted lower third molar removal, as follows: (1) sublingual
piroxicam-FDDF (fast dissolving dosage formulation) 20 mg/day; (2) oral
azithromycin 500 mg/day; (3)
piroxicam-FDDF 20 mg/day plus
azithromycin 500 mg/day. Oral
acetaminophen (500 mg
tablets) was allowed as rescue
analgesic medication.
Pain intensity was evaluated on a 100-mm visual-analogue scale after dental extraction (day 1), and at days 2, 3, 7 after surgery.
Edema and
trismus were estimated at days 2 and 7. At days 1 and 2,
pain intensity was significantly lower in patients treated with
piroxicam-FDDF, either alone (p < 0.05) or in combination with
azithromycin (p < 0.05), than in patients administered with
azithromycin alone. A higher
acetaminophen consumption was also recorded in the latter group (p < 0.01).
Pain intensity values did not differ among treatment groups at days 3 and 7. At day 2, the facial
edema was significantly less intense in patients exposed to
piroxicam-FDDF alone, as compared to patients treated with
azithromycin, either alone (p < 0.05) or in combination with
piroxicam-FDDF (p < 0.05). No significant differences were detected when comparing groups for
trismus at days 2 and 7. The present results indicate that, when given alone in the pre-operative period,
piroxicam-FDDF effectively counteracts
post-surgical pain and inflammatory reactions in oral tissues. Upon combined treatment with
piroxicam-FDDF and
azithromycin, the
macrolide antibiotic may reduce the influence of
piroxicam on post-operative
inflammation, without affecting its beneficial effect on surgical
pain.