J. Limeres Posse

Comparative Efficacies of Amoxicillin, Clindamycin, and Moxifloxacin in Prevention of Bacteremia following Dental Extractions

ABSTRACT 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.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.

An update on infective endocarditis of dental origin.

Abstract Objectives : The aim of this study was to analyse the prevalence of dental treatment and oral infections related to the development of infective endocarditis (IE). Methods : A retrospective study of 103 cases of IE diagnosed from 1997 to 1999 was conducted in Galicia, Spain. Results : According to the Dukes endocarditis criteria (1994), 87 cases (84.5%) were considered definite IE. A presumed oral portal of entry was recorded in 12 patients (13.7%). Oral infections were held responsible in six cases while the remaining six had received dental treatment in the previous three months (three tooth extractions, one scaling, one cleaning, one fillings). In eight cases of IE (66.6%) typical oral pathogenic microflora was identified, with Streptococcus viridans being the most frequent. In four patients no previous cardiac disease was recorded. Conclusions : These results suggest that prevalence and characteristics of IE cases of dental origin did not change significantly in the last decades. The need for increased oral hygiene and improved dental care should be emphasized on preventing IE of dental origin. Continued education of physicians and dentists on the importance of the knowledge of current prophylactic protocols should also be considered.

Intra-alveolar granulocytic sarcoma developing after tooth extraction

Granulocytic sarcoma (GS) is a malignant tumour composed of poorly differentiated myeloid cells forming in an extramedullary site. It is generally associated with acute leukaemia, particularly the myelocytic type. Its appearance in patients with chronic myeloid leukaemia is exceptional. GS can appear in multiple locations with the oral cavity being rarely involved. A mandibular GS detected in a patient with chronic myeloid leukaemia 10 days after a tooth extraction is reported. The pathogenesis (by metastastic cells or migration through the Haversian canals) of the tumour is discussed.

Bacterial endocarditis of oral etiology in an elderly population

The aim of this study was to analyze the prevalence and characteristics of bacterial endocarditis (BE) of oral origin in a group of elderly people. A retrospective study of 115 BE clinical records was performed, focusing on the demographic and predisposing features, as well as on the analytical and clinical variables. Twenty-two of the 115 cases were excluded as they were detected in intravenous drug users. Of the remaining 93 cases, 54.8% were diagnosed in patients older than 60 years of age (group A) and 45.2% in patients younger than 60 years (group B). There were 16 cases (17.2%) of oral origin; 4 BE cases mainly associated with tooth extractions were found in group A and 12 BE (most of them related with odontogenic abscesses) in group B. Within group A, 1 patient (25%) had not an underlying cardiac condition versus 5 cases (41.6%) in group B. Even though the prevalence of BE of oral origin in patients older than 60 is low, the high frequency of cardiopathies, poor oral health and high number of dental procedures shown by the old population makes them a risk group for BE of oral origin.

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

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.

Efficacy of fluoroquinolones against pathogenic oral bacteria.

This article reviews the characteristics of the main fluoroquinolones used in dentistry (ciprofloxacin, levofloxacin and moxifloxacin), including pharmacokinetic/ pharmacodynamic parameters, susceptibility profiles of oral bacteria and clinical trials on their efficacy in dental practice. It seems that some of these antibiotics might represent a safe alternative in patients with allergy, intolerance, or lack of response to beta-lactams.

Pautas de profilaxis antibiótica de la endocarditis bacteriana en pacientes sometidos a tratamiento odontológico

The objective of the present work was to know the guidelines of antibiotic prophylaxis in bacterial endocarditis used in different spanish health centers. A general dental practitioner asked orally in 50 Cardiology and/or Internal Medicine departments throughout Spain which prophylaxis should be administered to a patient with a mitral valve prosthesis before a dental extraction. The results obtained showed that only 36 (72%) departments used the latest prophylactic guidelines recommended by the American Heart Association or the British Society for Antimicrobial Chemotherapy. Among penicillin allergic patients the antibiotic of choice was erythromycin (60%) followed by clindamycin (28%), although administered at very different dosages (11 and 3, respectively). Only in 44% of the surveyed departments did the guidelines for allergic and non allergic patients correspond to the recommended protocol by the same study group. The controversy generated regarding the prophylactic indications for bacterial endocarditis might partially account for the results obtained in this study.

Eficacia clínica del moxifloxacino en el tratamiento de abscesos odontogénicos submucosos

Introduccion En la terapeutica de los abscesosodontogenicos a menudo es necesario prescribir un tratamientoantibiotico. El objetivo del presente estudio es analizarla eficacia clinica del moxifloxacino en el tratamiento farmacologicode abscesos odontogenicos. Metodos Se realizo un ensayo clinico comparando laeficacia de moxifloxacino y amoxicilina-acido clavulanico, administrados por via oral, en el tratamiento de abscesosodontogenicos en dos Unidades de Salud Bucodental de lared de Atencion Primaria del Servicio Gallego de Salud. Elgrupo de estudio lo compusieron 80 pacientes que presentabanabscesos odontogenicos submucosos. Tras una exploracioninicial, los pacientes se distribuyeron aleatoriamente endos grupos: A (recibieron moxifloxacino 400 mg/24 h/5 dias) y B (recibieron amoxicilina-acido clavulanico 500/125 mg/8h/7 dias). A todos los pacientes se les prescribio dexibuprofeno (400 mg/8 h/3 dias). La valoracion de las caracteristicasclinicas de los abscesos se efectuo aplicando una version modificadade los “Criterios de evaluacion de eficacia para antibioticos” de la Sociedad Japonesa de Cirugia Oral. Resultados Tras completar el tratamiento farmacologicolos pacientes fueron reevaluados. Ambos grupos evolucionaronpositivamente sin que se obtuviesen diferencias estadisticamentesignificativas en ninguna de las variablesanalizadas. El grado de adherencia al tratamiento fue mejorentre los pacientes tratados con moxifloxacino. Conclusiones Consideramos que en determinadas situacionescomo alergias a antibioticos beta-lactamicos o resistenciasa macrolidos, el moxifloxacino podria constituiruna alternativa en el tratamiento farmacologico de los abscesosodontogenicos submucosos.