The effect of oral decontamination with clindamycin palmitate on the incidence of bacteremia after esophageal dilation: a prospective trial.

Abstract

BACKGROUND:

Antibiotic prophylaxis to prevent bacterial endocarditis is recommended in high-risk patients undergoing esophageal dilation, a high-risk procedure. Some studies suggest that the oropharynx is the source of bacteremia. A topical antibiotic mouthwash, which reduces bacterial colonization of the oral flora, might decrease bacteremia rates and would be an attractive alternative to systemic administration of antibiotics.

METHODS:

Adults undergoing outpatient bougienage for a benign or malignant esophageal stricture were randomized in a clinician-blinded fashion to either pre-procedure clindamycin mouthwash or no treatment. Subjects were stratified by type of dilator used. Blood cultures were obtained immediately after the first esophageal dilation and 5 minutes after the last dilation.

RESULTS:

Fifty-nine patients were enrolled: 30 in the treatment arm and 29 in the no-treatment arm. There were 7 positive blood cultures: 5 in the treatment arm and 2 in the no-treatment arm. The identified organisms were Streptococcus viridans (2), Staphylococcus mucilaginous (2), Lactobacillus (2), and Actinomyces odontolyticus (1). Patients with bacteremia reported greater subjective difficulty with dysphagia (p = 0.01) irrespective of stricture diameter, procurement of biopsies, or dilator type.

CONCLUSIONS:

The percentage of cases with bacteremia for all dilations performed in this manner was 12% (95% CI [5.3, 23.6]), much lower than previously cited. All organisms in this study were oral commensals. There appears to be no effect of a clindamycin mouthwash on reducing bacteremia after esophageal dilation.

• Authors: W K Hirota, G W Wortmann, C L Maydonovitch, A S Chang, R B Midkiff, R K Wong, F M Moses
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 50 Issue 4 Pg. 475-9 (Oct 1999) ISSN: 0016-5107 [Print] United States
• PMID: 10502166 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Anti-Bacterial Agents
• Mouthwashes
• Clindamycin

Topics

• Aged
• Anti-Bacterial Agents (administration & dosage)
• Antibiotic Prophylaxis
• Bacteremia (microbiology, prevention & control)
• Bacteria (isolation & purification)
• Clindamycin (administration & dosage)
• Dilatation (adverse effects, instrumentation)
• Esophageal Stenosis (therapy)
• Female
• Humans
• Male
• Middle Aged
• Mouth (microbiology)
• Mouthwashes
• Prospective Studies
• Single-Blind Method