Impact of amoxicillin prophylaxis on the incidence, nature, and duration of bacteremia in children after intubation and dental procedures

Background - Controversy exists about the impact of prophylactic antibiotics on bacteremia after invasive dental procedures. The purpose of this double-blind, randomized, placebo-controlled study was to determine the impact of amoxicillin prophylaxis on the incidence, nature, and duration of bacteremia from nasotracheal intubation and dental procedures in children. Methods and Results - Children were randomly assigned before surgery to the American Heart Association (AHA) recommended dose of amoxicillin or to a placebo. Aerobic and anaerobic blood cultures were drawn at 8 specific time points after intubation, dental restorative and cleaning procedures, and before, during, and after dental extraction(s), to include blood drawings up to 45 minutes after the last extraction. Aerobic and anaerobic blood culture results were used to determine the incidence, nature, and duration of bacteremia from these procedures. For the 100 children enrolled ( mean age, 3.5 years), the overall incidence of positive blood cultures, defined as at least 1 positive culture of the 8, was significantly higher in the placebo (84%) than the amoxicillin group (33%) ( P < 0.0001). Bacteremia occurrence rates after intubation and after dental restorations and cleaning were 18% and 20% in the placebo group and 4% and 6% in the amoxicillin group (P = 0.05 and P = 0.07, respectively). At 1.5 minutes after the initiation of dental extractions, bacteremia occurred in 76% of the placebo group versus 15% of the amoxicillin group ( P < 0.001). The majority of the 152 positive cultures and of the 29 different bacteria identified were Gram-positive cocci. Bacteremia persisted longer in the placebo group. Conclusions - Bacteremia from these procedures occurs more often, from a wider variety of bacterial species, and for a longer duration after dental extractions than previously reported in any age group. Amoxicillin has a significant impact on the incidence, nature, and duration of bacteremia after nasal intubation, dental restorative and cleaning procedures, and dental extractions.