Antibiotic prophylaxis for endocarditis: time to reconsider

Abstract

Some cardiac conditions require antibiotic prophylaxis for some types of dental treatment to reduce the risk of infective endocarditis (IE). All medical and dental practitioners are familiar with this practice but tend to use different regimens in apparently similar circumstances. Generally, the trend has been to prescribe antibiotics if in doubt. This review explores the evidence for antibiotic prophylaxis to prevent IE: does it work and is it safe? The changing nature of IE, the role of bacteraemia of oral origin and the safety of antibiotics are also reviewed. Most developed countries have national guidelines and their points of similarity and difference are discussed. One can only agree with the authority who describes antibiotic guidelines for endocarditis as being ‘like the Dead Sea Scrolls, they are fragmentary, imperfect, capable of various interpretations and (mainly) missing!’ Clinical case‐controlled studies show that the more widely antibiotics are used, the greater the risk of adverse reactions exceeding the risk of IE. However, the consensus is that antibiotic prophylaxis is mandatory for a small number of high‐risk cardiac and high‐risk dental procedures. There are a large number of low‐risk cardiac and dental procedures in which the risk of adverse reactions to the antibiotics exceeds the risk of IE, where prophylaxis should not be provided. There is an intermediate group of cardiac and dental procedures for which careful individual evaluation should be made to determine whether IE or antibiotics pose the greater risk. These categories are presented. All medical and dental practitioners need to reconsider their approach in light of these current findings.

Caries experience in young children with congenital heart disease in a developing country

“…Even though the importance of good oral health in preventing bacteremia and infective endocarditis is widely known, 9,10,12,17,18 the majority of studies with heart disease patients of all ages report that the dental health of these subjects is usually poor. 2,4,5,7,19 A high caries index was found in the present study, in contrast with recent data on the whole Brazilian population, in which a mean dmft value of 2.43 was found for a 5-year-old population in which 46.6% were caries free.…”

A change of heart: the new infective endocarditis prophylaxis guidelines

“…Although there have been no case-controlled studies of IE in Australia, New infective endocarditis prophylaxis guidelines the Australian experience of IE has been well documented 11 and dental issues associated with IE have been investigated. 12,13 The UK guidelines 3 were carefully considered but it was decided that the abolition of antibiotic prophylaxis for all patients at risk of IE could not be supported at this time. Instead, the American guidelines 2 were adopted with one important modification to the cardiac conditions requiring prophylaxis (Table 1).…”

Effect of Antibiotic Prophylaxis on Serum CRP Level Immediately Following Periodontal Treatment: An Experimental Clinical Study

“…Therefore, the antibiotic may work before the bacteria enter the bloodstream, after they enter the bloodstream or on colonies of bacteria. The primary mechanism by which antibiotic prophylaxis could occur has not been established but a number of studies showed that bacteremia was reduced both in quantity and time in the presence of antibiotics [19]. Amoxicillin is bactericidal that is useful in treating the acute phase of odontogenic infection, in addition to prevention of associated complications.…”