Comparative effects of local and systemic antibiotic therapy in the prevention of postextraction bacteremia

An effective antibiotic cover for the prevention of endocarditis following dental and other post-operative bacteraemias

“…With penicillin the reductions varied from 9 % (Hirsch, Viveno, Merril, and Dowling, 1948) to 42 % (Schirger, Martin, Royer, and Needham, 1960). With antibiotics other than penicillin the reductions were 61 % (Khairat: the present work, the highest reduction ever obtained, in a series of 100 patients with 88 anaerobes isolated), 44 % (Roth, Cavallaro, Parrott, and Celentano, 1950) with aureomycin orally, 280% (Bender, Pressman, and Tashman, 1958) using streptomycin sulphate intramuscularly, and 25 % (Cooley and Haberman, 1957) with terramycin orally. The failure of some antibiotics completely to prevent the bacterial invasion of the blood stream after exodontia explains the occasional occurrence of endocarditis despite a penicillin cover.…”

“…However, it can be properly concluded that pyrrolidino methyl tetracycline was active against anaerobes as well as aerobes and that, in so far as one can argue from the results obtained in the present work, a substance of this class would be a good choice in any attempt to give cover before operative procedures, using the intravenous route, for a rapidly attained high concentration of circulating antibiotic. Bender et al (1958) administered 1 g. chloramphenicol in a single intravenous dose to 32 patients half an hour before extraction and obtained a reduction from 85 % to 22% positive blood cultures though they isolated no anaerobes in their work. They did not incorporate an inactivator in their blood culture medium as there is no inactivator known for chloramphenicol.…”

Bacteraemia following periodontal procedures

“…Several studies have investigated the type and frequency of bacteraemias induced following different dental procedures and quote varying incidences (Bender et al 1958, Rogosa et al 1960, Rise et al 1969, King et al 1988, Heimdahl et al 1990, Waki et al 1990, Lucartorto et al 1992, Hall et al 1993, Okabe et al 1995, Daly et al 1997, da Fonseca 1998. Few of these studies are comparable because of differences in detection methods used, timing of blood sampling following the procedure, volumes of blood sampled and procedures and the clinical variables measured.…”

The risk for endocarditis in dental practice

“…It is generally felt that bacteremia is influenced by the invasiveness and the duration of a procedure, and that dental extractions are the most likely of dental procedures to cause bacteremia, ranging from 10% to 94% in different studies (5,10,13,15,43,44,46,47,66,69,82). However, many studies are poorly controlled for invasiveness, the sequence of the surgical procedure, or the timing of the blood drawings in relation to the onset or completion of surgery.…”

“…Mouthrinse studies are difficult to evaluate, and the data are conflicting due to inconsistencies in study design as well as a lack of adequate sample size, randomization, examiner blinding, and control over other variables. Some studies have shown a benefit from chlorhexidine (53,71), 1% povidone-iodine (18,99), peroxyborate monohydrate (93), sodium perborate-ascorbic acid compound (39), a phenolated solution (24,54), and a variety of other topical antimicrobial agents when used as a rinse and/or an irrigant in the gingival sulcus prior to extraction or scaling procedures (14,15,31,49). However, a well-controlled study by Witzenberger showed no reduction in bacteremia from gingival scaling following a 1-minute rinse and a 3-minute sulcus irrigation with 10% povidone-iodine (113).…”