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 twentyone 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.

Microbiology of Odontogenic Bacteremia: beyond Endocarditis

“…Furthermore, it has been surmised that at least in healthy individuals, the bacteria are scavenged from the bloodstream relatively quickly by the innate and adaptive defense mechanisms (20,100). Despite this general contention, some studies indicate that an episode of odontogenic bacteremia could last as long as 60 min (39,110,132), and most studies report the presence of bacterial species in blood for up to 30 min (Table 2; Fig. 2).…”

“…This holds true for the isolates in experimental odontogenic bacteremias as well (Table 2). In a number of controlled clinical trials, streptococci were the predominant organisms isolated, ranging from 40 to 65% of isolates (39,48,109,110,132,140). Other genera of the Firmicutes family have been isolated from the bloodstream, to a lesser extent than streptococci, and include species of the Abiotrophia, Dialister, Selenomonas, and Solobacterium genera, in descending order.…”

“…Only a few procedures related to exodontia appear to reduce surgical bacteremias, and these include preoperative administration of antimicrobial agents, such as amoxicillin, cefuroxime, and moxifloxacin, that significantly reduce the incidence of such bacteremias (39,140). Moreover, broad-spectrum degerming rinses, such as povidone-iodine, chloramine-T, and chlorhexidine, have been shown to reduce the incidence of bacteremia when administered as a rinse or irrigation prior to the extraction procedure or instrumentation, and povidoneiodine was shown to be the most potent in reducing the incidence (84,121,127,144).…”

Comparative Efficacy and Safety of Moxifloxacin and Clindamycin in the Treatment of Odontogenic Abscesses and Inflammatory Infiltrates: a Phase II, Double-Blind, Randomized Trial

“…Clinically, MXF was shown previously to be effective for the prevention of bacteremia following dental extractions, whereas CLI was not (8). For the adjuvant therapy of patients with severe chronic periodontitis, MXF was more effective than DOX and reduced the bacterial load and all inflammatory parameters (11).…”

“…It has shown good bactericidal activity against Gram-positive and Gramnegative aerobic and anaerobic pathogens, including those that cause odontogenic infections (8,17,22). The activity of MXF is comparable to that of amoxicillin-clavulanate (AMX-CLA) but better than those of CLI, metronidazole (MET), and PEN (17).…”