A Man Took Antibiotics Before Going to the Dentist

July 21, 2019

SAN FRANCISCO – As scary as it sounds, a root canal is a fairly routine dental procedure. But for one 60-year-old man, the procedure turned life-threatening when he developed meningitis, a swelling of the tissues surrounding his brain and spinal cord. More surprisingly, this dangerous outcome wasn’t the result of a dentist’s drill or a germ-coated dental tool that went horribly awry. In fact, the surgical procedure went off without a hitch.

But a few days after the procedure, the man arrived at a New Jersey emergency room with a fever, headache and neck pain. He told the doctor that he had recently had a root canal and mentioned that his dentist had instructed him to take amoxicillin – a common antibiotic – a few days before the surgery.

Because of his symptoms, the doctors suspected he had meningitis, which is almost always caused by an infection of some kind. So, they started him on antibiotics, but his condition only got worse.

At that point, the doctors treating him suspected that he might have drug-induced meningitis, or that the symptoms of meningitis were not triggered by an infection, but by a specific drug. And in this case, that drug is amoxicillin.

Such side effects are rare, says Dr. Maria Nagori, an infectious disease physician at Geisinger Community Medical Center in Scranton, Pennsylvania, who treated the patient in 2017.Nagori says, “It’s a really unusual thing, I’ve never heard of it before.” At the time of the case, Nagori was completing a fellowship at Cooper University Hospital in Camden, New Jersey.

In fact, upon further research, Nagori found that only a dozen cases of meningitis caused by amoxicillin had been reported.

On Oct. 4, Nagori presented the man’s case report at IDWeek, a conference of several organizations focused on infectious diseases. The report has not yet been published in a peer-reviewed journal.

When tests for various infections came back negative, doctors stopped the man’s antibiotic treatment and he began to get better. At a follow-up appointment, he was doing well, Nagori told Live Science.

After further questioning, the doctor learned that the man had suffered from meningitis twice before: in 2011 and 2015. Each time, his meningitis symptoms occurred after he took amoxicillin prior to dental surgery. But because the man had been treated at several different hospitals, a rare side effect, no one linked him to amoxicillin until he was treated in 2017.

What’s more, the man didn’t have any medical conditions or risk factors that would cause him to need antibiotics before a dental procedure such as a root canal, which Nagori says means antibiotics are unnecessary.

Nagori and colleagues advised the patient to stop taking amoxicillin. Instead, he could take the antibiotic clindamycin.