A Phase 4 interventional study of Clindamycin and Doxycycline in Bacteremia and Endocarditis, sponsored by University of Santiago de Compostela. Not yet recruiting at 1 site in Spain. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2024-06-17.
Sponsored by University of Santiago de Compostela · Phase 4, Interventional, and Prevention
Although controversy exists regarding the efficacy of antibiotic prophylaxis for patients at risk of infective endocarditis, expert committees continue to publish recommendations for antibiotic prophylactic regimens. The last American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines include several important changes, highlighting that clindamycin (CLI) is no longer recommended as an alternative to amoxicillin in those allergic to penicillin. This new project aims to evaluate the effectiveness of oral doxycycline in preventing post-dental extraction bloodstream infection.
PURPOSE: Despite the controversy about the risk of developing bacterial endocarditis of oral origin, numerous Expert Committees in different countries continue to publish prophylactic regimens. To date, the literature is unclear about the role of antimicrobial prophylaxis in the prevention of bacteremia following dental procedures. The aim of this study is to evaluate the efficacy of prophylactic dosage with oral doxycycline (DXC) in the prevention of bacteremia following dental extractions.
SELECTION OF THE STUDY GROUP AND STUDY DESIGN: The study group will comprise patients who, for behavioral reasons (autism, learning disabilities, phobias, etc.), will undergo dental extractions under general anesthesia in the Santiago de Compostela University Hospital (Santiago de Compostela, Spain). 150 patients will be selected and will be randomly distributed into 3 study groups: control group (receiving no prophylaxis), CLI group (receiving 600 mg oral CLI) and DXC group (receiving 100 mg oral DXC).
COLLECTION OF SAMPLES FOR BLOOD CULTURE: To determine the prevalence of bacteremia, a peripheral venous blood sample (10 ml) will be drawn from each patient. Samples will be inoculated in BACTEC plus (Becton Dickinson and Company, Sparks, MD) aerobic and anaerobic blood culture bottles, and will be processed in the Bactec 9240 (Becton Dickinson).
MICROBIOLOGICAL ANALYSIS OF BLOOD CULTURES: A Gram stain will be performed on each positive blood culture. The positive blood cultures in the aerobic media will be subcultured on blood agar and chocolate agar in an atmosphere of 5 to 10% carbon monoxide and on MacConkey agar under aerobic conditions. The same protocol will be used for the positive blood cultures in the anaerobic media, with subculture on Schaedler agar and incubation in an anaerobic atmosphere. The bacteria isolated will be identified by using the battery of biochemical tests provided with the Vitek system for Gram-positive bacteria, Neisseria spp., Haemophilus spp., and obligate anaerobic bacteria. The viridans group streptococci will be classified into five groups, the Streptococcus mitis, S. anginosus, S. salivarius, S. mutans, and S. bovis groups, by applying the Ruoff criteria. Facklam's criteria will be used to identify unusual Streptococcus spp. and other Gram-positive cocci in chains.
The subculture and further identification of the isolated bacteria will be performed by conventional microbiological techniques. The collection, handling, and transport of the blood samples for blood culture will be performed according to the recommendations of the Spanish Society of Infectious Diseases and Clinical Microbiology.
297 studies on the registry are indexed under Bacteremia; 51 are open to participants now.
This study's planned enrollment of 150 is close to the median of 156 across 156 interventional studies indexed under Bacteremia.
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Exclusion Criteria:
Receiving no prophylaxis
Receiving 600 mg oral Clindamycin 1 hour before general anesthesia and before any dental manipulation
Drug: Clindamycin
Receiving 100 mg oral Doxycycline 1 hour before general anesthesia and before any dental manipulation
Drug: Doxycycline
Receiving 600 mg oral Clindamycin 1 hour before general anesthesia and before any dental manipulation
Receiving 100 mg oral Doxycycline 1 hour before general anesthesia and before any dental manipulation
Bacteremia in participants receiving a prophylactic dosage with oral doxycyclin
Positive cultures
Time frame: Changes from baseline at 30 seconds and 15 minutes after the final dental extraction
Bacteremia in participants receiving a prophylactic dosage with oral clindamycin
Positive cultures
Time frame: Changes from baseline at 30 seconds and 15 minutes after the final dental extraction
Bacteremia in participants receiving no prophylaxis
Positive cultures
Time frame: Changes from baseline at 30 seconds and 15 minutes after the final dental extraction
Plan to share: Yes — IPD will be available on request
Supporting information: Clinical study report
Time frame: By the end of the study (for 1 year)
Access criteria: On request
This study is not yet recruiting, as verified in Jun 2024. You cannot join it, but the record below documents what was studied.
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Studies of the drugs tested here: Clindamycin · Doxycycline
University of Santiago de Compostela