Amoxicillin is safer than clindamycin when used to prevent endocarditis

The main objective of antibiotic prophylaxis (AP), prescribed before invasive dental procedures, is the prevention of infectious endocarditis. However, for a sufficiently long period, the risk of developing undesirable drug reactions resulting from this type of practice is worrying. The objective of the study, published in the April issue of the journal Journal of Antimicrobial Chemotherapy, was to determine the frequency and nature of adverse drug reactions with amoxicillin and clindamycin as an antibiotic prophylaxis for infective endocarditis.

Information on the UK PA prescription from January 2004 to March 2014 was obtained from the NHS Business Services Authority database, and information on adverse drug reactions was obtained from the Medicines and Health Products Regulatory Agency yellow card. Amoxicillin was administered once at a dose of 3 g orally, clindamycin - also once at a dose of 600 mg orally and was used in patients allergic to penicillin.

The frequency of NLRs reported on amoxicillin was 0 fatal reactions for 1 million appointments (in fact, 0 fatal reactions for approximately 3 million appointments) and 22.2 non-fatal reactions for 1 million appointments -you. For clindamycin, the frequency of fatal reactions was 13 cases per 1 million appointments and the frequency of non-fatal reactions was 149 cases per 1 million appointments. Most clindamycin NLRs are infections caused by Clostridium difficile.

Thus, during the analysis, it was demonstrated that in the United Kingdom, the frequency of NLR for drugs used for the antibiotic prophylaxis of infectious endocarditis is low (in particular for amoxicillin). In addition, it turned out to be significantly lower than expected. At the same time, the use of clindamycin as an agent for BP is associated with a statistically significantly higher frequency of fatal and non-fatal HLR, which is mainly due to C. difficult infection . These NLR frequency indicators for clindamycin were higher than previously thought and were comparable to the same frequency when using clindamycin for other indications at different doses, different durations of treatment and other routes of administration.