Comparison of intravenous teicoplanin with intramuscular amoxycillin for the prophylaxis of streptococcal bacteraemia in dental patients.

Teicoplanin 400 mg, given as an intravenous bolus dose after induction of general anaesthesia, was highly effective in reducing the prevalence of streptococcal bacteraemia following dental extraction. Pulse rate and blood pressure monitoring did not show any adverse cardiovascular reactions after this dose which was extremely well tolerated. Blood samples were collected from adult patients for culture and antibiotic assay about two minutes after the dental procedure. Viridans streptococci were isolated from one of 40 patients receiving teicoplanin (2.5%) compared with 13 of 40 (32.5%) control patients. Another group of patients investigated received amoxycillin 1.0 g, intramuscularly shortly before anaesthesia, and viridans streptococci were isolated from 10 of 40 (25%) patients in this group. The mean serum teicoplanin and amoxycillin concentrations at the time of extraction were 37 and 10 mg/l respectively. Although amoxycillin was administered with lignocaine patients occasionally complained of pain following intramuscular injection. The results of this study suggest that the 400 mg intravenous bolus dose of teicoplanin is more suitable than 1.0 g intramuscular amoxycillin for the parenteral prophylaxis of streptococcal endocarditis in patients with cardiac lesions who require a dental procedure. Also as the teicoplanin dose is easy to administer and free of cardiovascular reactions or 'red man' syndrome it is probably more suitable than vancomycin for providing prophylaxis in patients allergic to penicillin.