Antibiotic Prophylaxis Effective After Dental Procedures to Prevent Endocarditis: JAMA

A comprehensive review underscores the protective role of antibiotic prophylaxis in preventing infective endocarditis among the high-risk patients following invasive dental procedures. The key highlights of this study were published in the Journal of American Medical Association.

This study meticulously analyzed data up to May 2023 and cast new light on the long-debated effectiveness of the antibiotic prophylaxis guidelines established since 2007. The investigation looked into an extensive array of databases, including PubMed, Cochrane-CENTRAL, Scopus and several others. After sifting through a total of 11,217 records, this study included 30 studies that encompassed over 1.1 million infective endocarditis cases.

The results from this analysis revealed significant reduction in the risk of developing infective endocarditis following dental procedures for patients who received antibiotic prophylaxis in five out of eight studies. Also, the high-risk individuals benefited substantially where the pooled relative risk (RR) of 0.41 indicated a 59% reduced risk when compared to the individuals who did not receive antibiotics. This data aligns well with the recommendations of leading health organizations such as the American Heart Association and the European Society of Cardiology.

These findings from the time-trend analyses gave out a more complex picture. While 9 studies observed no significant change in the incidence of infective endocarditis post-guideline implementation, 7 reported including those at moderate and high risk across various populations was positive. 3 studies, however, did note a significant decline, especially among cases of oral streptococcus-related endocarditis.

This difference in time-trend results underlines the precise impact of antibiotic prophylaxis guidelines over time and across different patient demographics. However, the consensus from more controlled study designs suggests a clear protective benefit of antibiotic prophylaxis for high-risk individuals that reaffirms the current health recommendations.

For moderate-risk patients, the evidence remains inconclusive by highlighting a critical gap in current research and elucidating the need for targeted studies to address this uncertainty. In conclusion, this systematic review supports the continued use of antibiotic prophylaxis in preventing infective endocarditis among the high-risk patients who undergo invasive dental procedures. This calls for a clear interpretation of time-trend data and urges further research to reveal the role of prophylaxis in moderate-risk groups that ensures patient safety and optimal health outcomes.

Source:

Sperotto, F., France, K., Gobbo, M., Bindakhil, M., Pimolbutr, K., Holmes, H., Monteiro, L., Graham, L., Hong, C. H. L., Sollecito, T. P., Lodi, G., Lockhart, P. B., Thornhill, M., Diz Dios, P., Turati, F., & Edefonti, V. (2024). Antibiotic Prophylaxis and Infective Endocarditis Incidence Following Invasive Dental Procedures. In JAMA Cardiology. American Medical Association (AMA). https://doi.org/10.1001/jamacardio.2024.0873