Bacteremia following dental procedures may lead to
bacterial endocarditis in susceptible patients. Traditional methods of
chemoprophylaxis with a parenteral loading dose of
penicillin followed by oral
penicillin have proved impractical outside the hospital. In 1978, it was suggested in England that
amoxicillin be substituted as the
drug of choice in the prophylaxis of
bacterial endocarditis. The recommended mode of treatment was a single oral dose of 3 g
amoxicillin administered 1 hour before onset of the dental procedure.
Amoxicillin is absorbed to a greater extent and more rapidly than
penicillin V. It maintains its effectiveness throughout the critical postoperative period at concentrations well over the minimum necessary to combat Streptococcus viridans.
Amoxicillin has two mechanisms of protection: bactericidal and inhibition of bacterial adherence to the thrombotic vegetation on injured heart valves. Data obtained from 206 susceptible patients undergoing dental treatment under
chemoprophylaxis with
amoxicillin showed that in no case did
infective endocarditis occur. Only in 13.1% of the patients could very mild side effects of this
drug be observed. With this new method, there is a higher incidence of patient compliance and administration is easier to supervise.