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Penicillin treatment in oral surgery in patients with coagulation disorders
Abstract:
There are clinical observations indicating that the frequency of postoperative bleeding after oral surgery in patients with coagulation disorders is reduced by prophylactic antibiotic treatment. To assess this effect, the concentrations of phenoxymethylpenicillin in plasma and saliva were determined during treatment and compared with the MIC values for penicillin of the oral bacteria of four patients with coagulation disorders. The concentration of penicillin in plasma of the patients considerably exceeded the MIC values of all isolated bacteria. In mixed saliva and saliva of the parotid and submandibular glands no penicillin activity could be detected. The bacteria isolated from the oral cavity of the patients did not in vitro exhibit either fibrinolytic or plasminogen activator activity. Thus, the oral bacteria of patients with coagulopathies probably do not cause an increased bleeding tendency by their intra- or extracellular enzymes.
Insights
Prophylactic antibiotic treatment may reduce postoperative bleeding in oral surgery patients with coagulation disorders. However, penicillin was not detected in saliva, suggesting bacteria do not cause bleeding via enzymes.
Area of Science:
- Oral surgery
- Coagulation disorders
- Pharmacokinetics
Background:
- Clinical observations suggest prophylactic antibiotics reduce postoperative bleeding in patients with coagulation disorders.
- The mechanism behind this potential effect remains unclear.
Purpose of the Study:
- To assess the effect of prophylactic phenoxymethylpenicillin on postoperative bleeding in oral surgery patients with coagulation disorders.
- To determine penicillin concentrations in plasma and saliva and compare them to bacterial Minimum Inhibitory Concentrations (MICs).
Main Methods:
- Phenoxymethylpenicillin plasma and saliva concentrations were measured in four patients with coagulation disorders undergoing oral surgery.
- MIC values for penicillin against isolated oral bacteria were determined.
- Bacterial fibrinolytic and plasminogen activator activity was assessed in vitro.
Main Results:
- Penicillin plasma concentrations significantly exceeded MIC values for all isolated oral bacteria.
- No penicillin activity was detected in mixed saliva or saliva from parotid and submandibular glands.
- Isolated oral bacteria did not exhibit significant fibrinolytic or plasminogen activator activity in vitro.
Conclusions:
- Prophylactic phenoxymethylpenicillin achieves adequate plasma concentrations to inhibit oral bacteria in patients with coagulation disorders.
- The absence of penicillin in saliva suggests it does not act locally in the oral cavity.
- Oral bacteria likely do not contribute to increased bleeding tendency in these patients through enzymatic activity.