309. Antimicrobial Use and Endocarditis Risk in Patients after Extractions
Session: Poster Abstract Session: Assessing and Reducing Infection Risk
Friday, October 21, 2011
Room: Poster Hall B1

The Remote Area Medical® (RAM) provides free health care and dental care to medically underserved populations. Throughout 2010, RAM conducted 21,190 teeth extractions. Routine prophylactic antibiotic use after tooth extraction is controversial due to antimicrobial anaphylactic reactions and the rare prevalence of endocarditis. This study aimed to assess endocarditis risk factors and antimicrobial allergy in the patients receiving antimicrobials after extractions by RAM. 


A survey study collecting demographic data, drug allergy, previous medical history, current medications, and antimicrobial regimens of the subjects at the 2009 RAM, Wise, VA.  Adult subjects were included if receiving antimicrobials at RAM, agreement to participate by signing the consent form, and his/her dental chart was available for review. The dental charts were retrospectively reviewed for dental procedures and presence of infection. This study was approved by the Virginia College of Osteopathic Medicine Internal Review Board and RAM.


Of a total 124 subjects, 22 had a history of penicillin allergy and their reactions were anaphylaxis (4 subjects), rash (11), gastrointestinal discomfort (2), and unknown reactions (5). Thirty five patients reported to have heart diseases or be on cardiovascular medications. The most common antimicrobial was amoxicillin (87), which was followed by clindamycin (18) and penicillin VK (18). Periodontal involvement was reported in 3 patients, 7 had infections, and all the patients received routine (105) or/and surgical (11) extractions. The median number of teeth extracted was 4 with a maximum of 26. Among the subjects with penicillin allergy, 5 (2 anaphylaxis and 3 rash) presented prescriptions for amoxicillin.


Among patients receiving antimicrobials after extraction at the 2009 RAM, Wise, VA, only one third had cardiovascular history/risk factors for endocarditis, and 5 had prescription for amoxicillin in spite of a history of penicillin allergy.

Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Su Young Lee, Pharm.D., Pharmacy Practice, Appalachian College of Pharmacy, Oakwood , VA, Michael Jones, Pharm.D., Pharmacy, LewisGale Medical Center, Salem, VA and Daniel Weber, Pharm.D., Pharmacy Practice, Appalachian College of Pharmacy, Oakwood, VA


S. Y. Lee, None

M. Jones, None

D. Weber, None

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