Topical antibiotic prophylaxis for bacteremia after dental extractions.
ABSTRACT Current prophylaxis for endocarditis in patients undergoing dental procedures consists of oral administration of amoxicillin. There is concern that the risk of anaphylaxis from systemically administered antibiotics might approach the incidence of endocarditis. Emergence of resistance among bacteria is also favored by systemically administered antibiotics. The present study was designed to assess the efficacy of topical amoxicillin given prophylactically as a mouthwash in reducing the incidence of bacteremia after dental extraction.
Thirty-six outpatients in a dental clinic were randomized in a 3:2:2 ratio to experimental prophylaxis of topical amoxicillin (3 g per mouthwash rinse; 15 patients), standard prophylaxis of oral amoxicillin (3 g in a single dose; 11 patients), or no prophylaxis (10 patients), respectively. Patients were stratified by severity of periodontal disease and number of teeth extracted. Data were analyzed for differences in the incidence of bacteremia by means of the 2-tailed Fisher exact test.
Breakthrough bacteremia after dental extraction was observed in 60% (6 of 10 patients) who received topical amoxicillin and in 89% (8 of 9 patients) who received no prophylaxis (P =.30). By comparison, breakthrough bacteremia after dental extraction was observed in 10% (1 of 10 patients) who received standard prophylaxis with oral amoxicillin (60% vs 10%; P =.05).
Topical amoxicillin decreased the incidence of bacteremia in comparison with no prophylaxis, but statistical significance was not achieved (P =.30). Topical amoxicillin was significantly less effective than standard prophylaxis with oral amoxicillin in decreasing the incidence of bacteremia after dental extractions.
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ABSTRACT: We evaluated some of the regimens recommended for the antimicrobial prophylaxis of infective endocarditis prior to dental extraction in 160 patients. Group A patients served as the control group, group B subjects rinsed their mouths with chlorhexidene, group C subjects took 3 g amoxicillin orally and group D patients took 600 mg clindamycin orally. The proportion of patients who had post-extraction bacteraemia in groups A, B, C and D was 35, 40, 7.5 and 20%, respectively. The differences between the control and amoxicillin groups (p = 0.003) and between the chlorhexidine and amoxicillin groups (p = 0.0006) were statistically significant. Streptococci were not isolated in any patients in the amoxicillin and clindamycin groups. In our study, none of the regimens were effective in preventing post-extraction bacteraemia.Cardiovascular journal of Africa. 10/2012; 23(9):491-4.
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ABSTRACT: OBJECTIVE: The purpose of this study was to directly compare the incidence and magnitude of bacteremia of a 0.12% chlorhexidine pre-procedure rinse to the AHA and the ADA/AAOS recommended 2 g amoxicillin antibiotic prophylaxis during third molar extractions. STUDY DESIGN: This study was a randomized, blind, placebo-controlled prospective clinical trial involving subjects assigned to a placebo, rinse, or antibiotic group. The incidence and magnitude of bacteremia were analyzed via χ2 and Kruskal-Wallis/Friedman tests, respectively. RESULTS: There was no statistically significant difference in the incidence and magnitude of bacteremia between the three groups. However, the placebo group apparently resulted in the largest range and highest mean magnitude of bacteremia, followed by the rinse then the antibiotic group. CONCLUSIONS: The results of this novel study may reasonably conclude an oral rinse or systemic antibiotic antimicrobial intervention does not statistically reduce the incidence and magnitude of bacteremia compared to no antimicrobial intervention.Oral surgery, oral medicine, oral pathology and oral radiology. 02/2013;