Teicoplanin as a prophylactic antibiotic for dental bacteraemia

The potential of teicoplanin, a new glycopeptide antibiotic, was assessed according to its ability to decrease the occurrence and severity of bacteraemia following dental extraction. Preliminary studies with ten volunteers showed that mean peak serum concentrations of teicoplanin were reached 3 hours after intramuscular administration and were 2.6 mg/l (1.5 mg/kg regimen) and 5.0 mg/l (3 mg/kg regimen). Three groups of ten patients participated in the bacteraemia study. Group one received no prophylaxis whereas groups two and three received 200 mg of teicoplanin intramuscularly, or 3 g amoxycillin orally respectively, 1 h prior to extraction. Sequential blood cultures were inoculated at timed intervals from a single venous blood sample taken 2 min after commencing surgery. Bacteraemia was detectable in all patients who received no prophylaxis whereas those given teicoplanin and amoxycillin had detectable bacteraemia in 6/10 and 4/10 cases, respectively. Teicoplanin was clearly effective in reducing the incidence and degree of post dental extraction bacteraemia although apparently rather less so than amoxycillin. In-vitro tests of susceptibility and bactericidal activity showed that teicoplanin possesses comparable activity to those antibiotics which are either in use or have been used for the suppression of bacteraemia following dental extraction.