Clinical and microbiological efficacy of single dose cefuroxime prophylaxis for dental surgical procedures

In a prospective controlled randomised trial of 59 patients the effect of a single dose of cefuroxime before multiple tooth extractions on the clinical findings and occurrence of bacteraemia was studied. In one group 1.5 g cefuroxime was administered intravenously 10 min before start of surgery. A total of 118 blood samples were collected after 10 and 40 min. The cefuroxime group had a significantly lower rate of bacteraemia (33%) compared with the control group (86%). The predominant bacteria were gram-positive cocci. Fifty four different strains of bacteria were isolated, of which most were susceptible to cefuroxime. However seven strains which were susceptible to cefuroxime in vitro, were isolated from blood cultures of the treated group. Serum concentrations of cefuroxime ranged from 52.3 to 141.6 mg/l at 10 min and 32.6 to 91.8 mg/l at 40 min with a mean of 78.6 and 55.1 mg/l respectively. The only other factor which had a significant influence on the rate of bacteraemia was the number of extracted teeth. Oral hygiene and periodontal status did not significantly affect bacteraemia. There were no wound infections in any of the groups. During these dental interventions, sufficient plasma levels of antibiotic prevented bacteraemia. Selected patients might benefit from single-dose-prophylaxis with cefuroxime in preparation for dental surgery.