By Emma Yasinski
In recent years, dentists, doctors, and even farmers have been encouraged to limit their use of antibiotics, as concerns proliferate about increases in antibiotic-resistant bacteria.
A recent study published in the Journal of the American College of Cardiology reviewed the use of antibiotic prophylaxis in dental patients. After their investigation, the study authors make clear that there still is an essential place for the practice – at least in patients with high risk for life-threatening infective endocarditis – before invasive dental surgery. And those dentists who aren’t using antibiotic prophylaxis may be putting patients at risk.
In 2007, the American Heart Association (AHA) introduced new guidelines suggesting that dentists confine the use of antibiotic prophylaxis to those patients with a high risk of contracting infective endocarditis, i.e., patients with certain heart diseases or suppressed immune systems.
Previously, the worldwide standard was to provide it to patients with moderate or high risk. In the UK, the National Institute for Health and Care Excellence (NICE) took these new guidelines a step further, recommending in 2008 that dentists avoid the technique in all patients. Those new guidelines have since been adopted by some dentists around the globe.
“Clearly, with such a serious disease we need to know if the AHA recommendations are correct, if we should stop antibiotic prophylaxis completely as recommended by NICE or if those at moderate- and high-risk of infective endocarditis should be receiving prophylaxis,” Martin Thornhill, MBBS, BDS, PhD, Professor of Translational Research in Dentistry at the University of Sheffield’s School of Clinical Dentistry, and lead author of the study told Incisor.
Dr. Thornhill and his team conducted a study assessing how frequently antibiotic prophylaxis was used in both the US and the UK in moderate-risk or high-risk patients, as well as how many new cases of infective endocarditis emerged using data from Medicare and commercial health care from 2003-2015.
As expected, the number of patients at moderate-risk for infective endocarditis to receive antibiotic prophylaxis fell dramatically (64%) in response to the new guidelines. However, the number of high-risk patients to receive antibiotic prophylaxis also fell 20%.
There was a slight increase in the number of moderate-risk patients who contracted the infection, which the researchers described as “barely significant.” There was a much more significant increase (177%) in the number of high-risk patients who were infected.
“Our study strongly supports the AHA recommendation that those at high-risk of infective endocarditis should receive antibiotic prophylaxis. It also suggests that the 2008 NICE recommendation to stop antibiotic prophylaxis completely might have been wrong and could have put some individuals at unnecessary risk of developing endocarditis that could have been prevented,” said Dr. Thornhill.
He also emphasized that research will need to be done to figure out exactly why dentists have decreased the use of antibiotic prophylaxis in patients who are clearly high-risk and encourage them to resume prescribing it.
“We need to know why dentists are failing to give antibiotic prophylaxis to a significant number of those at high risk of infective endocarditis and what can be done to ensure that those patients who would benefit from it are offered it,” he added.
Author: Contributing writer Emma Yasinski received her Master of Science (MS) in science and medical journalism from Boston University. Her articles have also appeared at TheAtlantic.com, Kaiser Health News, NPR Shots, and Genetic Engineering and Biotechnology News.
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