21
Volume2 Issue2
|
N
ews and
E
vents
A2014 study
1
published in
TheLancet
shows the incidence of infective endocarditis (IE)grew followinga sharpdrop in
antibioticprophylaxis prescriptions forpatients at riskof developing this potentially fatal condition.The trendwas observed
inEngland followinga2008 recommendationfrom theNational Institute forHealthandCareExcellence (NICE)
2
to stop
prescribingantibioticprophylaxis solely for thepreventionof IE.
UK study shows
Increase In InfectiveEndocarditis
AfterDrop In
AntibioticProphylaxisPrescriptions
“I think it’s important tounderstand thatwhile this is a
well-conducted study, it doesnot causally link thedrop
inantibioticusewith the increase innewcasesof IE,”
saysDr. CarlosQuiñonez, chair of CDA’sClinical and
ScientificAffairsCommittee.
Incontrast to theNICEguidance, CDA’spositionon
preventionof IE
3
recommends the short-termuse
of antibioticsprophylacticallybefore routinedental
andmedical procedures for patients at greatest risk
of developing IE. TheCDApositionalignswith2007
guidelines from theAmericanHeartAssociation (AHA).
4
“We recommend thatCanadiandentists continue
following the2007AHAguidelines,” saysDr. Quiñonez.
“Theseguidelines identify thosepatients at greatest
riskof developing IEandprovide informationabout the
appropriateantibioticcoverageneeded.”
Dentists issuemajorityof
antibioticprophylaxis
prescriptions
Before theNICEguidelineswere introduced in
2008, prescribingof antibioticprophylaxis for
preventionof IEhadbeen fairlyconstant in
England: a single3gdoseof oral amoxicillin
or, for patients allergic topenicillin, a
600mgdoseof oral clindamycin. Using
dataonantibioticprophylaxisprescribing
practicesover roughly9years (4years
before theNICEguidelines and5years
afterwards), researchers reportedadramaticdecrease
inantibioticprescribing. Themeannumber of antibiotic
prophylaxisprescriptionspermonth fell from10,900
(pre-guidelines) to2236 (post-guidelines), eventually
reachingameannumber of 1307during the last
6monthsof the study. Roughly90%of the
prescriptionswere issuedbydentists andmostwere
for amoxicillin.
Only thoseat greatest riskof developing infective
endocarditis should receive short-termpreventive
antibioticsbeforecommon, routinedental andmedical
procedures. Peoplewho should takeantibiotics include
thosewith:
1. prostheticcardiacvalveor prostheticmaterial used for
cardiacvalve repair
2. ahistoryof infectiveendocarditis
3. certain specific, serious congenital (present frombirth)
heart conditions, including:
• unrepairedor incompletely repairedcyanotic
congenital heart disease, including
• thosewithpalliative shunts andconduits
• acompletely repairedcongenital heart defectwith
prostheticmaterial or device,whether placedby
surgeryor bycatheter intervention, during thefirst
sixmonths after theprocedure
• any repairedcongenital heart defectwith residual
defect at the siteor adjacent to the siteof a
prostheticpatchor aprostheticdevice
4. acardiac transplant that develops aproblem ina
heart valve.
Antibioticprophylaxis is recommended for patientswith
theaboveconditionswhoundergoanydental procedure
that involvesmanipulationof gingival tissuesor the
periapical regionof a toothand for thoseprocedures that
perforate theoralmucosa. The followingprocedures and
events
donotneedprophylaxis
:
• routineanesthetic throughnoninfected tissue
• dental radiographs
• placement of removableprosthodonticor
orthodonticappliances
• adjustment of orthodonticappliances
• placement of orthodonticbrackets
• sheddingof deciduous teeth
• bleeding from trauma to the lipsormucosa
