By Dr Jonathan Shurlock, edited by Dr. Ahmed El-Medany
Guidelines regarding antibiotic prophylaxis for infective endocarditis prior to dental procedures vary across the world. The National Institute for Health and Care Excellence currently do not recommend routine antibiotic prophylaxis in this setting.[1] The European Society of Cardiology recommend the use of antibiotics for specific dental procedures or for those at high risk of infective endocarditis.[2] Both guidelines acknowledge the lack of reliable data exploring this topic.
Professor Martin Thornhill has attempted to further investigate this topic and provide further reliable data. The authors carried out a cohort study of a large United States based cohort of patients receiving employer-provided commercial healthcare and those reiving medi-care based healthcare.
7,951,972 participants were enrolled. 3,744 (475 cases per million) were admitted to hospital with infective endocarditis. 1,292 (34.2%) of those admitted were deemed high risk for infective endocarditis at baseline, 831 (22.0%) at moderate risk, and 1,651 (43.8%) at low or unknown risk.
In the group with high baseline risk for infective endocarditis there was a significant temporal association between infection and dental procedure in the previous 4 weeks (OR: 2.00; 95% CI: 1.59-2.52; P = 0.002). The strongest temporal relationship was seen with dental extractions (OR: 11.08; 95% CI: 7.34-16.74; P < 0.0001) and oral-surgical procedures (OR: 50.77; 95% CI: 20.79-123.98; P < 0.0001).
Based on the authors data antibiotic prophylaxis was associated with a significant reduction in infective endocarditis. The strongest association between antibiotic prophylaxis and reduction in infective endocarditis incidence was again seen in the dental extraction (OR: 0.13; 95% CI: 0.03-0.34; P < 0.0001) and oral surgical procedure (OR: 0.09; 95% CI: 0.01-0.35; P = 0.002) groups.
Professor Thornhill’s findings add new data to the evidence base and suggest that decisions and official guidelines regarding antibiotic prophylaxis need to be based on individual risk of infective endocarditis and the specific procedure being performed.
See the full study here: https://www.sciencedirect.com/science/article/abs/pii/S0735109722055371
See NICE guidance here: https://www.nice.org.uk/guidance/CG64/chapter/Recommendations#prophylaxis-against-infective-endocarditis
See ESC guidance here:
https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Infective-Endocarditis-Guidelines-on-Prevention-Diagnosis-and-Treatment-of
