Intravenous antibiotic regimens and prophylaxis of odontogenic bacteraemia.
OBJECTIVE
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.


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.
Roberts
G
G
Department of Paediatric Dentistry, The Eastman Dental Institute and University College London, 256 Gray's Inn Road, London WC1X 8LD. g.roberts@eastman.ucl.ac.uk
Holzel
H
H
D000293:Adolescent; D000583:Amikacin / Q000008:administration & dosage; D000667:Ampicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D016470:Bacteremia / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D017742:Dental Care for Chronically Ill / Q000379:methods*; D003793:Dental Restoration, Permanent; D004359:Drug Therapy, Combination / Q000008:administration & dosage; D005491:Focal Infection, Dental / Q000517:prevention & control*; D006330:Heart Defects, Congenital; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D012189:Retrospective Studies; D017334:Teicoplanin / Q000008:administration & dosage; D014081:Tooth Extraction
D000900:Anti-Bacterial Agents; D017334:Teicoplanin; D000667:Ampicillin; D000583:Amikacin