Effect of repeated high dose prophylaxis with amoxycillin on the resident oral flora of adult volunteers.

Healthy adult volunteers received either single or repeated 3-g doses of amoxycillin by mouth at weekly intervals on three occasions. The salivary flora of each volunteer was monitored before, during and up to 11 weeks after the final dose of antibiotic. Viable counts of anaerobic bacteria, streptococci and streptococci resistant to amoxycillin 2 mg/L and 40 mg/L were determined in samples of saliva. All 20 volunteers harboured low numbers of streptococci resistant to amoxycillin 2 mg/L (mean count = 6.57 X 10(3) cfu/ml of saliva) before administration of the antibiotic; much lower carriage rates (45%) were observed for bacteria resistant to amoxycillin 40 mg/L (mean count = 116 cfu/ml of saliva). Each dose of amoxycillin had a rapid but transient effect on the numbers of salivary bacteria. A placebo lacking the antibiotic had no effect. A single 3-g dose of amoxycillin had little or no effect on the numbers of resistant streptococci and, therefore, it was concluded that in patients at risk of infective endocarditis a second prophylactic dose would not be invalidated. The numbers of resistant streptococci increased significantly after the second and third doses of amoxycillin, and persisted for 4-7 weeks. Consequently, in at-risk patients requiring repeated dental procedures liable to produce bacteraemia, either alternative antibiotic regimens should be used each time or intervals of at least 4 weeks should be left between treatment sessions.