Endocarditis cases.

OBJECTIVES: To analyse the antibiotic prescribing trends for exodontia and minor oral surgery in patients with a history of radiotherapy. Also, to evaluate the use of hyperbaric oxygen as a separate modality in the prevention of osteoradionecrosis. DESIGN: A survey of antibiotic prescribing involving the analysis of a questionnaire which included the management of three patients with a history of head and neck malignancy. METHOD: The heads of the departments in each unit in the UK were sent a closed-response questionnaire. Antibiotic prescribing was assessed in three case scenarios. Case one referred to a patient that had surgery alone as part of the management of head and neck cancer, who needed the surgical removal of second molar roots. Case two referred to a patient that had surgery and adjuvant radiotherapy as part of the management of head and neck cancer, and needed the same procedure as in case one. Case three included a patient with a history of surgery and adjuvant radiotherapy, who required the extraction of three mobile and periodontally-involved lower incisors. Consultants were also asked about the use of hyperbaric oxygen in the patients who had radiotherapy as part of their treatment strategy. RESULTS: A total of 109 questionnaires were sent to all the Maxillofacial Units in the UK. The response rate was 73%. In patients with a history of radical surgery alone for the management of head and neck cancer, 20% of the surgeons advocated pre-operative antibiotics for the surgical removal of lower posterior teeth. In contrast, in the patient with a history of adjuvant radiotherapy 86% supported pre-operative antimicrobial use for the surgical removal of the same teeth. In the extraction of mobile and periodontally involved lower incisors in the previously irradiated patient, 63% of the clinicians supported pre-extraction antibiotics. Postoperative antibiotics were advocated in 52% in the first case, 89% in the second case and 71% in the third case. 34% of the clinicians advocated hyperbaric oxygen for surgical removal of posterior teeth and 15% for the extraction of mobile anterior teeth. CONCLUSIONS: The use of peri-extraction antibiotics was favoured among oral and maxillofacial surgeons. There was little enthusiasm towards the use of hyperbaric oxygen as a prophylactic measure, alone or in conjunction with an antimicrobial regime. Control randomised trials that will measure the effectiveness of hyperbaric oxygen and the appropriate use of antibiotics for prophylaxis in pre- and post-operative regimes are necessary to evaluate the use of these modalities.

Antibiotic Prophylaxis↗

PubMed2002

Prophylactic antibiotic use in transurethral prostatic resection: a meta-analysis.

PURPOSE: We reviewed the efficacy of antibiotic prophylaxis in men undergoing transurethral prostatic resection, a clean contaminated procedure. MATERIALS AND METHODS: We systematically reviewed randomized controlled trials of antibiotic prophylaxis for transurethral prostatic resection with a meta-analysis of the results. We identified 32 randomized controlled trials with 4,260 participants examining the postoperative bacteriuria incidence. An 8-trial subset with 1,979 participants examined postoperative septicemia occurrence. RESULTS: Prophylactic antibiotic use in patients at low risk undergoing transurethral prostatic resection significantly decreased bacteriuria and clinical septicemia incidence. The bacteriuria incidence decreased from 26% to 9.1% (relative risk reduction 65%, 95% confidence interval -56 to -73). The clinical septicemia incidence decreased from 4.4% to 0.7% (relative risk reduction 77%, 95% confidence interval -55 to -88). Effective antibiotic classes included quinolones, cephalosporins, co-trimoxazole and aminoglycosides. Treatment protocols of any duration were effective. Subgroup analysis of cephalosporin based trials indicated that short treatment protocols appeared more effective than single dose protocols. Based on these results if 1,000 patients with sterile urine undergoing transurethral prostatic resection were given prophylactic antibiotics, bacteriuria would be avoided in 175, while septicemia would be prevented in 9 to 20. CONCLUSIONS: Antibiotic prophylaxis significantly decreases the incidence of bacteriuria and clinical septicemia in men with preoperative sterile urine undergoing transurethral prostatic resection. A significant decrease in bacteriuria incidence can be achieved with a range of antibiotic agents, including quinolones, cephalosporins and co-trimoxazole. Short course antibiotic protocols may be more effective than single dose regimens.

Antibiotic Prophylaxis↗