Single-Oral-Dose Azithromycin Prophylaxis against Experimental Streptococcal or Staphylococcal Aortic Valve Endocarditis

Τσίτσικα, Άρτεμις; Pefanis, Angelos; Donta, Ismini; Karayiannakos, Panayiotis; Giamarellou, Helen

doi:10.1128/aac.44.6.1754-1756.2000

Cited by 5 publications

(5 citation statements)

References 13 publications

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“…Azithromycin 500 mg oral suspension is recommended as an alternative in patients that are unable to take oral medication or patients that are allergic to penicillin. The available evidence from animal models on IE supports the efficacy of this drug as a prophylactic agent against oral streptococci (Girard et al 1993, Rouse et al 1997, Tsitasika et al 2000.…”

Section: Which Nonsurgical Endodontic Procedures Require Ap?mentioning

confidence: 86%

Endodontics and infective endocarditis – is antimicrobial chemoprophylaxis required?

Brincat¹,

Savarrio²,

Saunders

2006

Int Endodontic J

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The purpose of this review is to evaluate the evidence implicating nonsurgical endodontic procedures in inducing infective endocarditis (IE). The literature is reviewed and findings about dental procedures that elicit bacteraemia [in particular root canal treatment (RCT)], sequelae of bacteraemia, relationship between IE and RCT and variation between antibiotic prophylaxis (AP) guidelines are highlighted. At present, there is still significant debate as to which dental procedures require chemoprophylaxis and what antibiotic regimen should be prescribed. Currently, there are insufficient primary data to know whether AP is effective or ineffective against IE. Practitioners are bound by current guidelines and medico-legal considerations. Thus, the profession requires clear, uniform guidelines that are evidence-based.

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Section: Which Nonsurgical Endodontic Procedures Require Ap?mentioning

confidence: 86%

Endodontics and infective endocarditis – is antimicrobial chemoprophylaxis required?

Brincat¹,

Savarrio²,

Saunders

2006

Int Endodontic J

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“…Several models of experimental endocarditis have shown these agents to be effective alternatives to amoxicillin. [52][53][54] The newer macrolides are a suitable alternative to amoxicillin for both penicillin-allergic patients and those at risk of being colonised by High risk Prosthetic cardiac valves, including bioprosthetic and homograft valves Previous bacterial endocarditis Complex cyanotic congenital heart disease (e.g. single ventricle states, transposition of the great arteries, tetralogy of Fallot) Surgically constructed systemic-pulmonary shunts or conduits…”

Section: Newer Macrolidesmentioning

confidence: 99%

Antibacterials for the Prophylaxis and Treatment of Bacterial Endocarditis in Children

et al. 2001

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Although the overall incidence of infective endocarditis in the paediatric population is considered to be low, over the last 20 years a rising trend in infective endocarditis has been observed among children. This could be due to several reasons including the availability of improved diagnostic techniques, use of continuous central venous catheters and cardiac implants increasing the risk of infection, and the survival of a greater number of infants with congenital heart disease as a result of improved medical management. The predominant causative organisms of paediatric endocarditis include staphylococci and streptococci. There is increased concern surrounding the emergence of endocarditis in children caused by methicillin-resistant Staphylococcus aureus and drug resistant strains of Streptococcus pneumoniae. The treatment approach to paediatric endocarditis is similar to that for adult patients with endocarditis because of similarities in disease pathogenesis and aetiology. The therapeutic goal is to achieve sterilisation of the cardiac vegetations. The choice of antibacterial is dependent upon the susceptibility profile of the causative organism. Vancomycin or gentamicin is recommended for enterococcal endocarditis, according to guidelines from the American Heart Association. For staphylococcal endocarditis in patients with no prosthetic valve, oxacillin or nafcillin with or without gentamicin is the treatment of choice. In the case of endocarditis caused by methicillin-resistant S. aureus, vancomycin is commonly used in patients with no prosthetic valve and a combination of vancomycin, gentamicin and rifampicin (rifampin) for patients with prosthetic material. Cefazolin or ceftriaxone is the treatment of choice for penicillin allergic paediatric patients with endocarditis caused by viridans streptococci. While there have been no major changes in endocarditis therapy for the last decade, the current focus is on the recognition of multiple-drug resistant pathogens and the use of newer agents such as quinupristin/dalfopristin in the treatment of resistant bacterial endocarditis. Prophylactic antibacterial therapy is recommended for procedures thought to be associated with the occurrence of bacteraemia involving organisms commonly associated with endocarditis. These include dental extractions and oral, respiratory tract, genitourinary, gastrointestinal or oesophageal procedures. Prophylactic antibacterials recommended by the American Heart Association during genitourinary and gastrointestinal surgical procedures in high risk patients include ampicillin + gentamicin or vancomycin + gentamicin in high risk patients with penicillin allergy. Ampicillin has been recommended for prophylaxis of bacterial endocarditis in children undergoing oral, respiratory tract or oesophageal procedures. In the case of penicillin allergy in these patients, cephalosporins, clindamycin, azithromycin or clarithromycin have been recommended. The general consensus is that antibacterial prophylaxis during dental procedure is unnecessary, an...

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“…Cardiac infection developed in 88% of animals not receiving prophylaxis, in 9% of those receiving erythromycin, and in only 0-2.5% of those receiving the other antibiotics (Rouse et al, 1997). It has been demonstrated that azithromycin is effective in preventing experimental streptococcal endocarditis (protecting 94% of animals challenged with Streptococcus oralis), but, against methicillin-resistant Staphylococcus aureus-challenged animals, it was less effective than vancomycin (59% and 94%, respectively) (Tsitsika et al, 2000).…”

Section: (4) Efficacy Of Antibiotic Prophylaxis In the Prevention Of mentioning

confidence: 99%

Efficacy of Antibiotic Prophylactic Regimens for the Prevention of Bacterial Endocarditis of Oral Origin

2007

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Despite the controversy about the risk of individuals developing bacterial endocarditis of oral origin, numerous Expert Committees in different countries continue to publish prophylactic regimens for the prevention of bacterial endocarditis secondary to dental procedures. In this paper, we analyze the efficacy of antibiotic prophylaxis in the prevention of bacteremia following dental manipulations and in the prevention of bacterial endocarditis (in both animal models and human studies). Antibiotic prophylaxis guidelines remain consensus-based, and there is scientific evidence of the efficacy of amoxicillin in the prevention of bacteremia following dental procedures, although the results reported do not confirm the efficacy of other recommended antibiotics. The majority of studies on experimental models of bacterial endocarditis have verified the efficacy of antibiotics administered after the induction of bacteremia, confirming the efficacy of antibiotic prophylaxis in later stages in the development of bacterial endocarditis. There is no scientific evidence that prophylaxis with penicillin is effective in reducing bacterial endocarditis secondary to dental procedures in patients considered to be "at risk". It has been suggested that there is a high risk of severe allergic reactions secondary to prophylactically administered penicillins, but, in reality, very few cases have been reported in the literature. It has been demonstrated that antibiotic prophylaxis could contribute to the development of bacterial resistance, but only after the administration of several consecutive doses. Future research on bacterial endocarditis prophylactic protocols should involve the re-evaluation of the time and route of administration of antibiotic prophylaxis, and a search for alternative antimicrobials.

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Single-Oral-Dose Azithromycin Prophylaxis against Experimental Streptococcal or Staphylococcal Aortic Valve Endocarditis

Cited by 5 publications

References 13 publications

Endodontics and infective endocarditis – is antimicrobial chemoprophylaxis required?

Endodontics and infective endocarditis – is antimicrobial chemoprophylaxis required?

Antibacterials for the Prophylaxis and Treatment of Bacterial Endocarditis in Children

Efficacy of Antibiotic Prophylactic Regimens for the Prevention of Bacterial Endocarditis of Oral Origin

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