Metronidazole (MZ) and
levofloxacin (LF) are widely employed for treatment of
periodontitis, but high oral dose and resistance development after long-term
oral administration limit their use. The aim of this study was to alleviate shortcomings in the treatment of
periodontitis by fabrication of intrapocket, biodegradable films of
chitosan (CS) loaded with MZ and LF meant for inserting into
periodontal pockets to treat
infections. The films were developed by
solvent casting technique using
propylene glycol as
plasticizer and
glutaraldehyde as crosslinking agent. Their physical characteristics, such as
drug content, surface pH, swelling index, and folding endurance, exhibited results within limit. Further, FTIR and DSC studies revealed stability of films and compatibility between drugs and
excipients. SEM images of films showed the presence of free
drug particles on the surface causing burst effect. In vitro release in McIlvaine
buffer pH 6.6 was of sustained nature assisted by the burst effect. CS and crosslinking agent concentrations negatively affected drug release and positively affected T90 (time for releasing 90% of the
drug) due to altered matrix density. In contrast, the
plasticizer concentration increases membrane permeability and hence increased drug release, lowering T90. Crosslinked films demonstrated sustained release up to 7 days. The antibacterial efficacy of films was tested on Staphylococcus aureus and Escherichia coli, indicating good antibacterial activity. Clinical trials on patients proved the therapeutic efficacy of the films by a significant (p < 0.05) decrease in the
clinical markers of
periodontitis, i.e. gingival index, plaque index and pocket depth. Conclusively, the films of MZ and LF were successful tools for the management of
periodontitis.