Key Points
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Intravenous ampicillin is an effective drug regimen for reducing dental bacteraemia for comprehensive treatment under GA.
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If antibiotic resistant Staphylococcus aureus is a concern, alternative antibiotics to those published in the guidelines are required.
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A combination of teicoplanin IV and amikacin IV proved to be as effective an antibiotic regimen as ampicillin IV.
Abstract
Objectives This study retrospectively examines the efficacy of prophylactic intravenous antibiotic regimens in the prevention of odontogenic bacteraemia in children with severe congenital heart defects receiving comprehensive dental treatment under general anaesthesia.
Patients and methods Blood cultures were taken from children with congenital cardiac defects 30 seconds after completion of dental treatment under general anaesthesia. Antibiotic prophylaxis had been given intravenously immediately before dental treatment. The choice of antibiotics and the extent of dental treatment were recorded. The percentage prevalence of bacteraemia was compared with published data following multiple dental extractions using the same clinical and microbiological methodology.
Results The overall percentage prevalence of positive cultures in children receiving intravenous prophylactic antibiotics was 16%. The percentage of positive blood cultures in cardiac children who received ampicillin alone was not significantly different from that in children having a combination of amikacin and teicoplanin (16.7% v 22.2%) respectively [Chi Square = 0.385, df = 1, P = 0.535]. When compared with multiple extractions, both ampicillin alone and amikacin with teicoplanin were effective in reducing the prevalence of odontogenic bacteraemia.
Conclusions In children with cardiac defects, bacteraemia after dental treatment is reduced by antibiotics but is still detected on 16% of occasions. In comparison with children receiving ampicillin alone, the combination of amikacin and teicoplanin is as effective in reducing bacteraemia in children who are either allergic to penicillins or who have received them within the previous month.
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Acknowledgements
The authors thank Dr Michael Sury, Consultant Anaesthetist, for taking the majority of the blood samples for this project. We thank the staff of the Department of Microbiology at Great Ormond Street Hospital for Children and Guy's Dental Hospital for carrying out the work on the blood cultures. Also, Dr Aviva Petrie for advice on the statistical aspects of this report.
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Roberts, G., Holzel, H. Intravenous antibiotic regimens and prophylaxis of odontogenic bacteraemia. Br Dent J 193, 525–527 (2002). https://doi.org/10.1038/sj.bdj.4801617
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DOI: https://doi.org/10.1038/sj.bdj.4801617
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