Antibiotic prophylaxis for endocarditis with invasive dental procedures

January 01, 0001

Antibiotic prophylaxis for endocarditis with invasive dental procedures

In 2008, the National Institute for Health and Clinical Excellence (NICE) recommended that of antibiotic prophylaxis with invasive dental procedures in the United Kingdom. These UK and US researchers examined whether there was a change in antibiotic prophylaxis prescription patterns before for patients at risk of infective endocarditis, and if there was a change in the rate of infective endocarditis. They looked at all patients discharged from a hospital with a diagnosis of infective endocarditis.

The researchers found: "After the introduction of the NICE guideline there was a highly significant 78.6% reduction in prescribing of antibiotic prophylaxis, from a mean 10?277 prescriptions per month to 2292. Evidence that the general upward trend in cases of infective endocarditis before the guideline was significantly altered after the guideline was lacking. Using a non-inferiority test, an increase in the number of cases of 9.3% or more could be excluded after the introduction of the guideline. Similarly an increase in infective endocarditis related deaths in hospital of 12.3% or more could also be excluded."

The researchers concluded: "Despite a 78.6% reduction in prescribing of antibiotic prophylaxis after the introduction of the NICE guideline, this study excluded any large increase in the incidence of cases of or deaths from infective endocarditis in the two years after the guideline. Although this lends support to the guideline, ongoing data monitoring is needed to confirm this, and further clinical trials should determine if antibiotic prophylaxis still has a role in protecting some patients at particularly high risk."

A decreased use of prophylactic antibiotics for dental procedures was not associated with an increase in endocarditis.

For the full abstract, click here.

BMJ 342:d2392, 3 May 2011
© 2011 BMJ Publishing Group Ltd.
Impact of the NICE guideline recommending cessation of antibiotic prophylaxis for prevention of infective endocarditis: before and after study. Martin H Thornhill, Mark J Dayer, Jamie M Forde, et al. Correspondence to M H Thornhill: [email protected]

Category: K. Circulatory. Keywords: dental procedure, endocarditis, prophylaxis, amoxicillin, clindamycin, before and after study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 27 May 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.