Juan Medina Henríquez’s research while affiliated with University of Santiago de Compostela and other places

Objectives: Although controversy exists regarding the efficacy of antibiotic prophylaxis for patients at risk of infective endocarditis, expert committees continue to publish recommendations for antibiotic prophylaxis regimens. This study aimed to evaluate the efficacy of four antimicrobial regimens for the prevention of bacteraemia following dental extractions. Methods: The study population included 266 adults requiring dental extractions who were randomly assigned to the following five groups: control (no prophylaxis); 1000/200 mg of amoxicillin/clavulanate intravenously; 2 g of amoxicillin by mouth; 600 mg of clindamycin by mouth; and 600 mg of azithromycin by mouth. Venous blood samples were collected from each patient at baseline and at 30 s, 15 min and 1 h after dental extractions. Samples were inoculated into BACTEC Plus culture bottles and processed in the BACTEC 9240. Conventional microbiological techniques were used for subcultures and further identification of the isolated bacteria. The trial was registered at ClinicalTrials.gov with ID number NCT02115776. Results: The incidence of bacteraemia in the control, amoxicillin/clavulanate, amoxicillin, clindamycin and azithromycin groups was: 96%, 0%, 50%, 87% and 81%, respectively, at 30 s; 65%, 0%, 10%, 65% and 49% at 15 min; and 18%, 0%, 4%, 19% and 18% at 1 h. Streptococci were the most frequently identified bacteria. The percentage of positive blood cultures at 30 s post-extraction was lower in the amoxicillin/clavulanate group than in the amoxicillin group (P < 0.001). The incidence of bacteraemia in the clindamycin group was similar to that in the control group. Conclusions: Bacteraemia following dental extractions was undetectable with amoxicillin/clavulanate prophylaxis. Alternative antimicrobial regimens should be sought for patients allergic to the β-lactams.

We evaluated the efficacies of oral prophylactic treatment with amoxicillin (AMX), clindamycin (CLI), and moxifloxacin (MXF) in the prevention of bacteremia following dental extractions (BDE). Two hundred twenty-one adults who required dental extractions under general anesthesia were randomly assigned to a control group, an AMX group, a CLI group, and an MXF group (the individuals in the drug treatment groups received 2 g, 600 mg, and 400 mg, respectively, 1 to 2 h before anesthesia induction). Venous blood samples were collected from each patient at the baseline and 30 s, 15 min, and 1 h after the dental extractions. The samples were inoculated into BACTEC Plus aerobic and anaerobic blood culture bottles and were processed in a BACTEC 9240 instrument. Subculture and the further identification of the isolated bacteria were performed by conventional microbiological techniques. The prevalences of BDE in the control group, AMX group, CLI group, and MXF group were 96, 46, 85, and 57%, respectively, at 30 s; 64, 11, 70, and 24%, respectively, at 15 min; and 20, 4, 22, and 7%, respectively, at 1 h. Streptococcus spp. were the most frequently identified bacteria in all groups (44 to 68%), with the lowest percentage being detected in the AMX group (44%). AMX and MXF prophylaxis showed high efficacies in reducing the prevalence and duration of BDE, but CLI prophylaxis was noneffective. As a consequence, MXF prophylaxis is a promising antibiotic alternative for the prevention of BDE when beta-lactams are not indicated.

To analyze the importance of an individualized preoperative assessment in severely handicapped patients suitable of dental treatment under general anesthesia (GA). The study group consisted of 564 patients referred to a Special Needs Unit specialized in the dental care of handicapped people, who would be treated under GA. Medical and dental records of every patient were evaluated, as well as the findings in the oral examination and the assessment carried out by the anesthesiologists. Approximately 15% of patients (n=84) did not have any dental needs at the time of the examination; 42% (n=234) underwent treatment under GA and 43% (n=242) were treated under local anesthesia. Only 1.7% of the patients liable to undergo GA were discharged by the anesthesiologist due to their systemic condition. Medical and dental complications were scarce and, generally mild. During the follow-up period (mean 44 +/- 6 months) 4.8% of patients needed another treatment session under GA due to new dental pathology. Applying systematic selection criteria to perform any dental treatment under GA in severely handicapped patients reduces the indiscriminate use of this technique, minimizing complications as well as the necessity of new interventions.

Limeres-Posse J, Vázquez-García E, Medina-Henríquez J, Tomás-Carmona I, Fernández-Feijoo J, Diz-Dios P. Evaluación preanestésica de discapacitados severos susceptibles de tratamiento odontológico bajo anestesia general. Med Oral 2003;8:353-60. RESUMEN Objetivo: Analizar la importancia de la exploración preoperatoria individualizada de pacientes discapacitados severos suscepti-bles de tratamiento odontológico bajo Anestesia General (AG). Diseño: El grupo de estudio lo conformaron 564 pacientes remitidos a un centro especializado en la atención odontológica de pa-cientes especiales, para recibir tratamiento odontológico bajo AG. Se analizaron retrospectivamente los antecedentes médi-cos y odontológicos de todos los pacientes, así como los ha-llazgos de la exploración oral y los informes derivados de la consulta de anestesiología. Resultados: El 15% de los pacientes (n=84) no necesitaba tratamiento odontológico en el momento de la exploración. En el 42% de los casos (n=234) el tratamiento se realizó bajo AG y en el 43% de los pacientes (n=242) con Anestesia Local. De los enfermos susceptibles de AG sólo el 1,7% fue excluido por el anestesiólogo en base a su compromiso médico. Las compli-caciones tanto médicas como odontológicas fueron escasas y en general de baja intensidad. Durante el período de seguimien-to (media 44 ± 6 meses) en el 4,8% de los pacientes fue necesa-ria una nueva intervención bajo AG por la presencia de nueva patología dentaria. Conclusión: La aplicación sistemática de criterios de selección para efec-tuar tratamientos odontológicos bajo AG a discapacitados se-veros reduce el uso indiscriminado de esta técnica de control conductual, minimizando las complicaciones y la necesidad de reintervenciones.