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• W2018068135 abstract "Since the publication of the most recent American Heart Association recommendations for the prevention of bacterial endocarditis,1Prevention of Bacterial Endocarditis Recommendations of the American Heart Association.JAMA. 1997; 277: 1794-1801Crossref PubMed Google Scholar there seems to be an international consensus that only a single dose of oral amoxycillin is necessary for antibiotic prophylaxis. However, as members of the British Society for Antimicrobial Chemotherapy (BSAC) Endocarditis Working Party, we are anxious to avoid any confusion over the 2 g dose recommended for adults in the USA and the 3 g dose recommended in the UK and Europe. There is likely to be little difference in efficacy between the 2 g and 3 g amoxycillin doses, though a theoretical advantage of the 3 g dose is that higher serum concentrations of amoxycillin might be expected in some individuals after 10–12 h. This extended period of cover may be useful if additional risk factors are present, such as a strain of viridans streptococcus with a reduced susceptibility to amoxycillin.We understand that one of the reasons for recommending the 2 g dose in the USA was the unavailability of the 3 g sachet of amoxycillin powder, which is the mainstay of antibiotic prophylaxis in the UK. Dajani and colleagues2Dajani AS Bawdon RE Berry MC Oral amoxycillin prophylaxis for endocarditis: what is the optimal dose?.Clin Infect Dis. 1994; 18: 157-160Crossref PubMed Scopus (61) Google Scholar were not able to study this 3 g sachet but found that multiple tablets were better tolerated with a 2 g rather than a 3 g dose. A 2 g dose of oral amoxycillin was originally proposed for possible prophylaxis of endocarditis in 1978,3Shanson DC Cannon P Wilks M Amoxycillin compared with penicillin V for the prophylaxis of dental bacteraemia.J Anttimicrob Chemother. 1978; 4: 431-436Crossref PubMed Scopus (57) Google Scholar but subsequent work with the 3 g sachet showed a very good pharmacodynamic profile and patients’acceptability,4Littner MM Kaffe T Tamse A Buckner A New concept on chemoprophylaxis of bacterial endocarditis resulting from dental treatment.Oral Surg Oral Med Oral Path. 1986; 61: 338-342Summary Full Text PDF PubMed Scopus (12) Google Scholar and this inflenced the BSAC Endocarditis Working Party to recommend the 3 g dose.5British Society for Antimicrobial Chemotherapy Working Party Report. The antibiotic prophylaxis of infective endocarditis.Lancet. 1982; : 1323-1326Google Scholar There is now considerable experience with the 3 g sachet in the UK and Europe, and it has been widely accepted by dental practitioners because of convenient administration, under supervision, 1 h before a dental procedure and because it is well tolerated, which assists compliance. We therefore feel no need to change the current recommendation for a 3 g single dose of amoxycillin in the UK.Before dental treatment under a general anaesthetic, we have previously recommended administration of 1 g amoxycillin given in 2·5 mL of lignocaine hydrochloride 1% injection to reduce the pain of injection. The recently revised data sheet on amoxycillin advises that precipitation due to insolubility can occur in this mixture because the preparation is now manufactured with marginally higher concentrations of amoxycillin, to meet more stringent legal requirements. The suggestion of diluting the solution further to 5 mL and giving it as two injections seems to defeat the purpose since an extra injection would be required, and so we now wish to withdraw this alternative and merely advocate intravenous administration. Since the publication of the most recent American Heart Association recommendations for the prevention of bacterial endocarditis,1Prevention of Bacterial Endocarditis Recommendations of the American Heart Association.JAMA. 1997; 277: 1794-1801Crossref PubMed Google Scholar there seems to be an international consensus that only a single dose of oral amoxycillin is necessary for antibiotic prophylaxis. However, as members of the British Society for Antimicrobial Chemotherapy (BSAC) Endocarditis Working Party, we are anxious to avoid any confusion over the 2 g dose recommended for adults in the USA and the 3 g dose recommended in the UK and Europe. There is likely to be little difference in efficacy between the 2 g and 3 g amoxycillin doses, though a theoretical advantage of the 3 g dose is that higher serum concentrations of amoxycillin might be expected in some individuals after 10–12 h. This extended period of cover may be useful if additional risk factors are present, such as a strain of viridans streptococcus with a reduced susceptibility to amoxycillin. We understand that one of the reasons for recommending the 2 g dose in the USA was the unavailability of the 3 g sachet of amoxycillin powder, which is the mainstay of antibiotic prophylaxis in the UK. Dajani and colleagues2Dajani AS Bawdon RE Berry MC Oral amoxycillin prophylaxis for endocarditis: what is the optimal dose?.Clin Infect Dis. 1994; 18: 157-160Crossref PubMed Scopus (61) Google Scholar were not able to study this 3 g sachet but found that multiple tablets were better tolerated with a 2 g rather than a 3 g dose. A 2 g dose of oral amoxycillin was originally proposed for possible prophylaxis of endocarditis in 1978,3Shanson DC Cannon P Wilks M Amoxycillin compared with penicillin V for the prophylaxis of dental bacteraemia.J Anttimicrob Chemother. 1978; 4: 431-436Crossref PubMed Scopus (57) Google Scholar but subsequent work with the 3 g sachet showed a very good pharmacodynamic profile and patients’acceptability,4Littner MM Kaffe T Tamse A Buckner A New concept on chemoprophylaxis of bacterial endocarditis resulting from dental treatment.Oral Surg Oral Med Oral Path. 1986; 61: 338-342Summary Full Text PDF PubMed Scopus (12) Google Scholar and this inflenced the BSAC Endocarditis Working Party to recommend the 3 g dose.5British Society for Antimicrobial Chemotherapy Working Party Report. The antibiotic prophylaxis of infective endocarditis.Lancet. 1982; : 1323-1326Google Scholar There is now considerable experience with the 3 g sachet in the UK and Europe, and it has been widely accepted by dental practitioners because of convenient administration, under supervision, 1 h before a dental procedure and because it is well tolerated, which assists compliance. We therefore feel no need to change the current recommendation for a 3 g single dose of amoxycillin in the UK. Before dental treatment under a general anaesthetic, we have previously recommended administration of 1 g amoxycillin given in 2·5 mL of lignocaine hydrochloride 1% injection to reduce the pain of injection. The recently revised data sheet on amoxycillin advises that precipitation due to insolubility can occur in this mixture because the preparation is now manufactured with marginally higher concentrations of amoxycillin, to meet more stringent legal requirements. The suggestion of diluting the solution further to 5 mL and giving it as two injections seems to defeat the purpose since an extra injection would be required, and so we now wish to withdraw this alternative and merely advocate intravenous administration." @default.
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• W2018068135 title "Changes in recommendations about amoxycillin prophylaxis for prevention of endocarditis" @default.
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