Antibiotics and the Oral Streptococci of Man

The effects of 3 antibiotics, phenoxymethylpenicillin, cephalexin and clindamycin on the normal oral streptococcal flora in the region of the gingival crevice were investigated because these organisms are able to cause subacute bacterial endocarditis. Secretion of these antibiotics into the oral cavity was also examined. Penicillin and clindamycin exerted marked effects on the normal oral streptococci, whereas cephalexin did not cause any obvious change in the total flora. Following penicillin therapy, streptococci resistant to 1.5 μg/ml penicillin were observed and these organisms could be detected at least 8 weeks after the last dose of the antibiotic. They probably arose by selection from the mixed flora. Following cephalexin therapy, a much lower proportion of streptococci resistant to 15 μg/ml was found. The proportion of resistant strains fluctuated appreciably, however, probably due to their transient nature. Streptococci resistant to 1 μg/ml clindamycin were not observed in 10 out of 11 treated subjects.
Penicillin and clindamycin could be detected in the pooled saliva and gingival fluid after administering single doses of 500 mg and 300 mg, respectively. The peak levels were obtained between half and 1 h. The concentration of penicillin dropped rapidly within 3 h but clindamycin could be detected at significant levels for at least 6 h. No cephalexin could be detected in the pooled saliva or gingival fluid after a 500 mg dose. The implications of these findings in the prevention of subacute bacterial endocarditis are discussed.