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Intravenous amoxicillin/clavulanate for the prevention of bacteraemia following dental procedures: a randomized clinical trial.

Publication ,  Journal Article
Limeres Posse, J; Álvarez Fernández, M; Fernández Feijoo, J; Medina Henríquez, J; Lockhart, PB; Chu, VH; Diz Dios, P
Published in: J Antimicrob Chemother
July 2016

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.

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Published In

J Antimicrob Chemother

DOI

EISSN

1460-2091

Publication Date

July 2016

Volume

71

Issue

7

Start / End Page

2022 / 2030

Location

England

Related Subject Headings

  • beta-Lactamase Inhibitors
  • Young Adult
  • Treatment Outcome
  • Tooth Extraction
  • Prospective Studies
  • Middle Aged
  • Microbiology
  • Male
  • Humans
  • Female
 

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Limeres Posse, J., Álvarez Fernández, M., Fernández Feijoo, J., Medina Henríquez, J., Lockhart, P. B., Chu, V. H., & Diz Dios, P. (2016). Intravenous amoxicillin/clavulanate for the prevention of bacteraemia following dental procedures: a randomized clinical trial. J Antimicrob Chemother, 71(7), 2022–2030. https://doi.org/10.1093/jac/dkw081
Limeres Posse, J., M. Álvarez Fernández, J. Fernández Feijoo, J. Medina Henríquez, P. B. Lockhart, V. H. Chu, and P. Diz Dios. “Intravenous amoxicillin/clavulanate for the prevention of bacteraemia following dental procedures: a randomized clinical trial.J Antimicrob Chemother 71, no. 7 (July 2016): 2022–30. https://doi.org/10.1093/jac/dkw081.
Limeres Posse J, Álvarez Fernández M, Fernández Feijoo J, Medina Henríquez J, Lockhart PB, Chu VH, et al. Intravenous amoxicillin/clavulanate for the prevention of bacteraemia following dental procedures: a randomized clinical trial. J Antimicrob Chemother. 2016 Jul;71(7):2022–30.
Limeres Posse, J., et al. “Intravenous amoxicillin/clavulanate for the prevention of bacteraemia following dental procedures: a randomized clinical trial.J Antimicrob Chemother, vol. 71, no. 7, July 2016, pp. 2022–30. Pubmed, doi:10.1093/jac/dkw081.
Limeres Posse J, Álvarez Fernández M, Fernández Feijoo J, Medina Henríquez J, Lockhart PB, Chu VH, Diz Dios P. Intravenous amoxicillin/clavulanate for the prevention of bacteraemia following dental procedures: a randomized clinical trial. J Antimicrob Chemother. 2016 Jul;71(7):2022–2030.
Journal cover image

Published In

J Antimicrob Chemother

DOI

EISSN

1460-2091

Publication Date

July 2016

Volume

71

Issue

7

Start / End Page

2022 / 2030

Location

England

Related Subject Headings

  • beta-Lactamase Inhibitors
  • Young Adult
  • Treatment Outcome
  • Tooth Extraction
  • Prospective Studies
  • Middle Aged
  • Microbiology
  • Male
  • Humans
  • Female