Dental News - Study supports use of preventative antibiotic use in high-risk patients

Dental Tribune International

Fri. 9. November 2018

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SHEFFIELD, UK: Currently, the National Institute for Health and Care Excellence (NICE) guidelines recommend that dentists should generally not use antibiotic prophylaxis against infective endocarditis (IE) for patients undergoing invasive dental treatment. A new study of the American Heart Association (AHA) guidelines on this topic, however, has found that high-risk patients may benefit from continuing to receive this preventative therapy before treatment.

The study is the largest and most comprehensive research into the AHA’s 2007 recommendations that antibiotic prophylaxis should be given to patients at a high risk of developing IE, but not to those with a moderate risk. The findings showed that there had been a resultant 64 per cent decrease in antibiotic prescription for those at a moderate risk by 2015, though also a 20 per cent decrease for patients at a high risk. An estimated increase of 177 per cent in IE incidence in high-risk patients was subsequently noted.

“Although the data do not prove a cause–effect relationship between antibiotic prophylaxis reduction and IE increase, they are very supportive of the AHA recommendation to give antibiotic prophylaxis to those at high-risk but not to those at moderate-risk of endocarditis,” said lead author Prof. Martin Thornhill of the University of Sheffield’s School of Clinical Dentistry. “It also provides further evidence that the 2008 NICE recommendation that AP should cease completely in the UK was probably wrong and should be changed.”

“In the absence of clear and sensible advice from NICE, the recent attempt by the Scottish Dental Clinical Effectiveness Programme to provide advice for dentists about how to implement the NICE guidelines—effectively suggesting they follow the AHA recommendations—is very welcome,” he continued.

In 2015, Thornhill led a team at the University of Sheffield that identified that changes to the NICE guidelines in 2008 had led to an 89 per cent fall in preventative antibiotic prescription in the UK and an accompanying increase in cases of IE.

This new study provides further evidence to support the advice given by the AHA, and most other guideline committees around the world, that those at high-risk of IE undergoing invasive dental procedures should receive preventative antibiotic treatment.

The study, titled “Antibiotic prophylaxis and incidence of endocarditis before and after the 2007 AHA recommendations”, was published online in the Journal of the American College of Cardiology on 5 November 2018 ahead of inclusion in an issue. The findings will also be presented by Prof. Patrick O’Gara, Watkins Family Distinguished Chair in Cardiology at the Brigham and Women’s Hospital in Boston in the US, at the AHA Scientific Sessions in Chicago in the US on 11 November.

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One thought on “Study supports use of preventative antibiotic use in high-risk patients”

Peer Nelz says:

August 29, 2019 at 9:17 am

I never understood the change of NICE regulations in the first place!

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