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Prophylactic Amoxicillin and Clindamycin in Reducing Bacteraemia Following Dental Extraction
TAKE-HOME MESSAGE
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This study, consisting of 50 patients, aimed to evaluate the prevention of post-extraction bacteraemia following single-dose antibiotic prophylaxis prior to extraction. The patients were treated as follows: 76% received prophylactic oral amoxicillin or intravenous ampicillin (AMX/AMP; 2 g), 12% received clindamycin (CLI; 600 mg), and 12% received no prophylaxis (NO AP). All baseline blood cultures were negative. The prevalence of bacteraemia was significantly higher in the CLI and NO AP groups compared with the AMX/AMP group 5 minutes after the first tooth extraction. At 20 minutes after the last extraction, positive blood cultures were reported for CLI and NO AP groups.
- The authors concluded that AMX/AMP proved its efficacy in reducing both the prevalence and duration of bacteraemia, whereas CLI was not effective.
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVES
To evaluate the efficacy of single-dose antibiotic prophylaxis (AP) in the prevention of bacteraemia following tooth extractions at our clinic.
MATERIAL AND METHODS
Fifty patients undergoing tooth extractions were enrolled. The need of AP was determined according to the health status and possible allergies of the patients. Blood culture samples were collected at baseline, 5 min after the first tooth extraction and 20 min after the last extraction.
RESULTS
The majority (76%) received prophylactic oral amoxicillin or intravenous ampicillin (AMX/AMP) (2 g), 12% received clindamycin (CLI) (600 mg) and 12% received no prophylaxis (NO AP). All baseline blood cultures were reported negative. The prevalence of bacteraemia was significantly higher in the CLI and NO AP groups compared to the AMX/AMP group 5 min after the first tooth extraction (p < .0001 and p = .015, respectively). Twenty minutes after the last extraction positive blood cultures were reported only for CLI (p = .0015) and NO AP groups. There was no significant difference in the prevalence of positive blood cultures between CLI and NO AP groups.
CONCLUSIONS
Appropriately administered AMX/AMP proved its efficacy in reducing both the prevalence and duration of bacteraemia following tooth extractions whereas CLI was not effective in preventing bacteraemia following tooth extractions.
Additional Info
Prevalence of Bacteraemia Following Dental Extraction – Efficacy of the Prophylactic Use of Amoxicillin and Clindamycin
Acta Odontol. Scand. 2021 Jan 01;79(1)25-30, E Marttila, L Grönholm, M Saloniemi, R Rautemaa-RichardsonFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Clinical Dentistry
This is a study of 50 patients who underwent a varying number of tooth extractions by oral surgeons at Helsinki Hospital. Patients were randomized into groups receiving 2 grams oral amoxicillin or IV ampicillin (n =38), 600 mg IV clindamycin (n = 6) for patients with declared penicillin allergy, or no antibacterial prophylaxis. Anaerobic and aerobic blood cultures were drawn at baseline, 5 minutes after the first extraction, and 20 minutes after the end of the last extraction. In both treatment arms, 2 patients grew Streptococcus viridans at the second timepoint. None of the samples grew S. viridans at the third timepoint.
There are multiple concerns in the study, including the lack of description of the microbiology protocol and the statement that “[c]lindamycin was administered to patients allergic to penicillin as well as when the risk was moderate with the aim of covering a broader range of oral bacteria.” Over 16% of patients in the study were dropped because of incorrect blood draws. In addition, the data were collected in 2006 to 2008 and were not published until 2021.
The study concluded that the aminopenicillins used were effective against bacteremia. The conclusion that clindamycin use in antibiotic prophylaxis is ineffective and should be stopped is inappropriate, far overreaching the statistical power and value of this small study. Of note, a 2019 systematic review by Lafaurie et al1 stated that, “In patients with penicillin allergies, oral azithromycin showed a higher efficacy for the reduction of bacteremia and the use of clindamycin should be reviewed.”
Reference