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Intravenous administration of vancomycin is ineffective against bacteremia following tooth extraction
A Kaneko1, J Sasaki, J Yamazaki
1Department of Oral Surgery, Tokai University School of Medicine, Kanagawa, Japan.
Abstract:
The incidence of transient bacteremia after tooth extraction without antimicrobial prophylaxis has been reported was high as 69.2%; that with intravenous ampicillin as 4.2% (1, 2). Currently, we tested a regime of vancomycin that was recommended by the American Heart Association as prophylaxis for oral surgery patients who were allergic to penicillin and evaluated its effectiveness. Before the surgical procedures, we started an intravenous drip infusion of vancomycin. Ten of 26 patients became blood culture positive (38.5%). Seventeen strains of bacteria were isolated. The Minimum Inhibitory Concentrations (MICs) of vancomycin were lower than 3.13 micrograms/ml, with just one exception.
Insights
Vancomycin prophylaxis for penicillin-allergic patients undergoing oral surgery resulted in a 38.5% bacteremia rate. This study evaluated vancomycin
Area of Science:
- Oral Surgery
- Infectious Disease
- Pharmacology
Background:
- Transient bacteremia is common after tooth extraction without prophylaxis.
- Intravenous ampicillin shows a low incidence of bacteremia (4.2%).
- Penicillin-allergic patients require alternative prophylaxis for oral surgery.
Purpose of the Study:
- To evaluate the effectiveness of vancomycin as prophylaxis in penicillin-allergic patients undergoing oral surgery.
- To determine the incidence of bacteremia following vancomycin prophylaxis.
Main Methods:
- Prospective evaluation of vancomycin prophylaxis in 26 patients allergic to penicillin.
- Intravenous vancomycin administered before surgical procedures.
- Blood cultures performed to detect bacteremia.
Main Results:
- Ten of 26 patients (38.5%) developed transient bacteremia.
- Seventeen bacterial strains were isolated from positive blood cultures.
- Minimum Inhibitory Concentrations (MICs) for vancomycin were generally low (<3.13 µg/ml), with one exception.
Conclusions:
- Vancomycin prophylaxis in penicillin-allergic patients undergoing oral surgery resulted in a 38.5% bacteremia rate.
- Further research is needed to optimize antibiotic prophylaxis for this patient group.