Antibiotic prophylaxis before dental surgery ( Prophylaxis against infective endocarditis )
Antibiotics have in the past been offered routinely as a preventative measure to people at risk of infective endocarditis undergoing interventional procedures. However, there is little evidence to support this practice and antibiotic treatment presents a risk of adverse effects and the development of antibiotic resistance.
As a result, NICE guidelines now recommend that antibiotic prophylaxis and use of chlorhexidine mouthwash are no longer offered routinely for defined interventional procedures.
Some cardiologists, however, recommend that patients who are at very high risk or likely to have a significantly poorer outcome in terms of morbidity and mortality with IE may still benefit from antibiotic prophylaxis before certain procedures. This view is endorsed by the American Heart Association, The British Cardiovascular Society and the Society of Cardio Thoracic surgeons.
Patients at greatest risk of IE are those with
- prosthetic heart valve
- previous IE
- congenital heart disease (CHD)
- unrepaired cyanotic including palliative shunts and conduits
- completely repaired congenital heart defect with prosthetic material or device during fist 6 months after procedure
- repaired CHD with residual defects at site or adjacent to site of prosthetic patch or device
- cardiac transplantation recipients who develop cardiac valvulopathy
In these patients antibiotic prophylaxis is recommended only before dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa.
No prophylaxis is necessary even for very high risk patients otherwise.
The dentist would generally provide the expert advice and prescription for patients that may require antibiotic prophylaxis before more invasive dental treatment. The GP would not normally be involved in this decision making and prescribing, although patients may wish to discuss their concerns with their own GP as well.
CED 24/11/08
