Current trends in the prevention of bacterial endocarditis in susceptible patients receiving dental care

Myall, Robert W.T.; Gregory, Hugh S.

doi:10.1016/0030-4220(69)90332-6

Cited by 9 publications

(2 citation statements)

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“…The results also suggested that penicillinresistant streptococci were present in healthy individuals who had no previous experience of the antibiotic. The emergence of oral streptococci relatively resistant to penicillin following administration of the drug has been reported by many workers (Krumwiede, 1949;Garrod & Waterworth, 1962;Naiman & Barrow, 1963;Tozer, Boutflower & Gillespie, 1966; Stirland & Shotts, 1967;Sprunt, Redman & Leidy, 1968;Bentley, Frank & Hahn, 1971;Drucker & Jolly, 1971). The present study showed that resistant streptococci emerged within 24 h of taking penicillin and were still detected 8 weeks after discontinuing the antibiotic.…”

Section: Discussionsupporting

confidence: 79%

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Antibiotics and the Oral Streptococci of Man

Sukchotiratana

Linton

Fletcher

1975

Journal of Applied Bacteriology

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The effects of 3 antibiotics, phenoxymethylpenicillin, cephalexin and clindamycin on the normal oral streptococcal flora in the region of the gingival crevice were investigated because these organisms are able to cause subacute bacterial endocarditis. Secretion of these antibiotics into the oral cavity was also examined. Penicillin and clindamycin exerted marked effects on the normal oral streptococci, whereas cephalexin did not cause any obvious change in the total flora. Following penicillin therapy, streptococci resistant to 1.5 pg/ml penicillin were observed and these organisms could be detected at least 8 weeks after the last dose of the antibiotic. They probably arose by selection from the mixed flora. Following cephalexin therapy, a much lower proportion of streptococci resistant to 15 pg/ml was found.The proportion of resistant strains fluctuated appreciably, however, probably due to their transient nature. Streptococci resistant to 1 pg/ml clindamycin were not observed in 10 out of 11 treated subjects.Penicillin and clindamycin could be detected in the pooled saliva and gingival fluid after administering single doses of 500 mg and 300 mg,respectively. The peak levelswere obtained between half and 1 h. The concentration of penicillin dropped rapidly within 3 h but clindamycin could be detected at significant levels for at least 6 h. No cephalexin could be detected in the pooled saliva or gingival fluid after a 500 mg dose. The implications of these findings in the prevention of subacute bacterial endocarditis are discussed. Materials and MethodsEffect of antibiotics on the oral streptococci Subjects. These were volunteer students and staff of the Dental and Medical Schools. The age range was 20-50 years. They had not taken any antibiotics during the previous 6 months. All had clinically good dental hygiene with an Oral Hygiene Index (OHI-S) of 0.3-1 ' 5 , a reasonably good periodontal state with a Periodontal Index(P1-Russell) ofO. 1-1 * 7 (Russell, 1956) and no history of drug hypersensitivity. They were instructed not to clean their teeth for at least 10 h before sampling. Antibiotics administered to each group of subjectsPenicillin. Six subjects(Nos 1-6), 5 males and 1 female, were given 2 x 250mg phenoxymethyl penicillin tablets (penicillinv-Glaxo Laboratories) as a loading dose, followed by 250 mg 6 hourly for 3 days. Cephalexin.A 500 mg loading dose of ceporex (Glaxo Laboratories) was given to each of 7 male volunteers (Nos 7-13) and this was followed by 250mg 6-hourly for 4 days. The subjects in this study were divided into 2 groups. One group of 4 received the antibiotic in tablet form; the other group of 3 received the antibiotic as capsules. The object of this comparison was to determine whether transient antibiotic contamination of the oral cavity, which could occur with the tablet form of the drug, would affect the oral flora more than that produced by secretion of drug into the oral cavity.Clindamycin. Clindamycin (Dalacin C-Upjohn Ltd) in capsules was taken by 11 subjects (Nos 1424), all mal...

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Section: Discussionsupporting

confidence: 79%

“…In dental practice, an antibiotic cover is necessary to protect a person who is at risk to eliminate the bacteraemic organisms before they colonize the heart valves. The drug most commonly used is penicillin (Myall & Gregory, 1969). Other antibiotics are less frequently prescribed.…”

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confidence: 99%