Do patients at risk of infective endocarditis need antibiotics before dental procedures?

Cahill, Thomas J.; Dayer, Mark; Prendergast, Bernard

doi:10.1136/bmj.j3942

Cited by 24 publications

(21 citation statements)

References 19 publications

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“…In dental practice, antibiotics are either prescribed for prophylactic or therapeutic use. The indications for antibiotic prophylaxis in dentistry are essentially limited to the prevention of infectious endocarditis (IE) and the treatment of severely immunocompromised patients. Today, antibiotic prophylaxis in patients with the highest risk of IE is only recommended when the dental procedure is considered invasive and involves manipulation of gingival tissue or the periapical region of teeth, or perforation of the oral mucosa.…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial prescribing by Belgian dentists in ambulatory care, from 2010 to 2016

Struyf

Vandael

Leroy

et al. 2019

International Dental Journal

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Objectives To describe antimicrobial prescribing by Belgian dentists in ambulatory care, from 2010 until 2016. Materials and methods Reimbursement data from the Belgian National Institute for Health and Disability Insurance were analysed to evaluate antimicrobial prescribing (WHO ATC‐codes J01/P01AB). Utilisation was expressed in defined daily doses (DDDs), and in DDDs and packages per 1000 inhabitants per day (DID and PID, respectively). Additionally, the number of DDD and packages per prescriber was calculated. Results In 2016, the dentistry‐related prescribing rate of ‘Antibacterials for systemic use’ (J01) and ‘Antiprotozoals’ (P01AB) was 1.607 and 0.014 DID, respectively. From 2010 to 2016, the DID rate of J01 increased by 6.3%, while the PID rate declined by 6.7%. Amoxicillin and amoxicillin with an enzyme inhibitor were the most often prescribed products, followed by clindamycin, clarithromycin, doxycycline, azithromycin and metronidazole. The proportion of amoxicillin relative to amoxicillin with an enzyme inhibitor was low. The narrow‐spectrum antibiotic penicillin V was almost never prescribed. Conclusions Antibiotics typically classified as broad‐ or extended‐spectrum were prescribed most often by Belgian dentists during the period 2000–2016. Although the DID rate of all ‘Antibacterials for systemic use’ (J01) increased over the years, the number of prescriptions per dentist decreased since 2013. The high prescription level of amoxicillin with an enzyme inhibitor is particularly worrying. It indicates that there is a need for comprehensive clinical practice guidelines for Belgian dentists.

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Section: Introductionmentioning

confidence: 99%

Antimicrobial prescribing by Belgian dentists in ambulatory care, from 2010 to 2016

Struyf

Vandael

Leroy

et al. 2019

International Dental Journal

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“…This is possibly due to the relatively small sample size and lack of patient recall. This may also reflect the uncertainty in the direct link between dental procedure and infective endocarditis, which has been previously discussed . It is unclear if antibiotic prophylaxis would have prevented these cases.…”

Section: Discussionmentioning

confidence: 97%

“…This may also reflect the uncertainty in the direct link between dental procedure and infective endocarditis, which has been previously discussed. 29 It is unclear if antibiotic prophylaxis would have prevented these cases. Out of the 479 patients, there were three deaths during the study period, and these were unrelated to VSDs or IE.…”

Section: Discussionmentioning

confidence: 99%

Increased incidence of infective endocarditis in patients with ventricular septal defect

Lee

Foo

et al. 2018

Congenital Heart Disease

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Background Ventricular septal defect (VSD) is one of the most common congenital heart anomalies in childhood and there is an increasing prevalence of VSDs in the adult population. The long‐term risk of infective endocarditis (IE) is of concern. The aim of this study was to clarify and compare the incidence of IE in adults with repaired and unrepaired VSDs. Methods Patients with VSDs were identified using the Adult Congenital Heart Disease registry at the National Heart Centre Singapore. Patients were divided into Group 1 (repaired VSD) and Group 2 (unrepaired VSDs). The electronic medical records were searched for hospitalization due to IE during a 10‐year period (October 2, 2007—October 1, 2017). Results Four hundred seventy‐nine patients (53% male) were identified, with a mean age of 35.0 ± 13.7 years. There were 164 patients (34.2%) in Group 1 and 315 patients (65.8%) in Group 2. In total, there were eight episodes of IE from six patients (3 male, mean age of 42.2 ± 20.7 years). Two patients had recurrent IE. The overall incidence of IE was 1.67/1000 y, and this is 11–15‐fold higher compared to general adult population. The incidence of IE in Group 2 was 1.90/1000 y. There were no IE cases in Group 1. Conclusion Patients with VSDs, especially if unrepaired, carry a substantially increased risk of IE compared to the general population.

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“…In the present study, we observed that good oral hygiene, in terms of the plaque and inflammation parameters measured found among the SPT group, did not reduce the frequency or the degree of bacteremia caused by PMPR. It seems that there is such a low threshold for damage to the gingival barrier, as a result of local inflammation, that even minor inflammatory affections of the gingiva are sufficient to enable a detectable inoculation of bacteria into the blood (Cahill, Dayer, Prendergast, & Thornhill, ). In clinical practice, this means that there is still an indication for antibiotic prophylaxis in high‐risk patients who have undergone PMPR as a pretreatment.…”

Section: Discussionmentioning

confidence: 99%

Bacteremia after professional mechanical plaque removal in patients with chronic periodontitis

Beutler

Jentsch

Rodloff³

et al. 2019

Oral Diseases

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Objective The aim of this study was to investigate the characteristics of bacteremia caused by professional mechanical plaque removal (PMPR) in two groups of patients with generalized moderate chronic periodontitis. Materials and Methods Venous blood samples were taken at multiple time points for one hour following PMPR in fifty patients with generalized moderate chronic periodontitis. Subjects consisted of two groups, one group was receiving supportive periodontal therapy (SPT, n = 25) and the other group was receiving initial periodontal therapy (IPT, n = 25). Blood samples were processed and analyzed for cultivable microflora. Pertinent clinical parameters were recorded for each patient in both groups. Results Bacteremia was detected in 10 of 25 SPT and 8 of 25 IPT patients (p = 0.796). In both groups, the prevalence of bacteremia was dependent on the time of blood sampling and varied in magnitude between <102 CFU/ml and 106 CFU/ml. Sixteen different bacterial species were identified in both groups, mostly Actinomyces naeslundii (SPT n = 3, IPT n = 4) and Streptococcus spp. (SPT n = 6, IPT n = 2). In regression models, Grade II furcation involvement (p = 0.004) and Gingival Bleeding Index (p = 0.036) had affected the occurrence of bacteremia but in the SPT group only. Conclusion Professional mechanical plaque removal was associated with bacteremia regardless of whether a patient was receiving SPT or IPT.

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Do patients at risk of infective endocarditis need antibiotics before dental procedures?

Cited by 24 publications

References 19 publications

Antimicrobial prescribing by Belgian dentists in ambulatory care, from 2010 to 2016

Antimicrobial prescribing by Belgian dentists in ambulatory care, from 2010 to 2016

Increased incidence of infective endocarditis in patients with ventricular septal defect

Bacteremia after professional mechanical plaque removal in patients with chronic periodontitis

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