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.

Figures

FIG. 1.

Prevalence of bacteremia at the baseline and postextraction (30 s, 15 min, and 1 h after completion of the dental extractions) in the different study groups. BASELINE, blood simple drawn under basal conditions (after nasotracheal intubation and before any dental manipulation; these samples were obtained only from the 40 patients in the AMX, CLI, and MXF groups); 30 SEC, blood sample drawn 30 s after the final dental extraction; 15 MIN, blood sample drawn 15 min after completion of the surgical procedure; 1 H, blood sample drawn 1 h after completion of the surgical procedure (for purely technical reasons, it was possible to obtain the sample from 50 patients in the control group, 54 patients in the AMX group, and 56 patients in the MXF group).

FIG. 2.

Percentage of cumulative MICs of amoxicillin, clindamycin, and moxifloxacin for all strains isolated from the control group (62 isolates), amoxicillin group (24 isolates), clindamycin group (66 isolates), and moxifloxacin group (25 isolates).