Faculty Opinions recommendation of Comparative efficacies of amoxicillin, clindamycin, and moxifloxacin in prevention of bacteremia following dental extractions.

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Abstract
This study questions the efficacy of clindamycin in preventing post-dental extraction bacteraemia and thus bacterial endocarditis. Clindamycin, along with macrolides, are often recommended as a second line agent for penicillin-allergic patients and the finding that it may be inferior to amoxcillin is interesting; however, further evidence may be required to change practice. In this randomized controlled clinical trial, the proportion of patients with bacteraemia following clindamycin prophylaxis was similar to the control group, but was lower in patients that received either amoxicillin or moxifloxacin. The proportion of healthy patients with positive blood cultures was assessed 30 seconds, 15 minutes and 1 hour following dental extraction. 53 patients did not receive antibiotics, 56 received amoxicillin, 54 received clindamycin 600mg and 58 received moxifloxacin, all 1-2 hours prior to the procedure. The proportion with bacteraemia was highest 30 seconds following the procedure, with 96% of control patients, 85% of clindamycin patients, 57% of moxifloxacin and 46% of amoxicillin patients having bacteraemia. A high proportion of isolates were resistant to erythromcyin and clindamycin. Although it used a surrogate endpoint, and possibly reflects local Spanish susceptibility patterns, this study suggests that clindamycin may be inferior to amoxicillin and moxifloxacin in preventing bacterial endocarditis in susceptible hosts. Further study is needed to support this, in particular, additional evidence is needed of widespread in vitro resistance or clinical failure elsewhere.

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