International guidelines favor prophylactic antibiotics to prevent infectious endocarditis post dental procedure

The benefits of preventing infective endocarditis exceed the dangers of antibiotic resistance, according to three out of four CPGs, says an article published in Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology.

A serious infection that develops in the lining of the heart chambers is known as infective endocarditis. It can be caused by a fungus, although bacteria are most frequently to blame. Numerous dental operations produce bacteremia, which in a tiny percentage of cases can result in bacterial endocarditis. Despite having a low frequency, bacterial endocarditis has a significant fatality rate. Prior to invasive dental operations, guidelines in several nations advice giving antibiotics to those at high risk of endocarditis.

Heba Hussein and colleagues undertook this study in order to evaluate the effectiveness of clinical practice recommendations for the use of antimicrobial prophylaxis to avoid infective endocarditis in authorized dental treatments.

For this investigation, databases examined between January 2011 and January 2022 included CINAHL/EBSCO, Medline/OVID, and EMBASE. It includes rules created from scratch but omitted any that had been modified, adopted, or published before 2011. Four reviewers used the Appraisal of Guidelines for Research & Evaluation (AGREE II) Instrument to independently evaluate the guidelines.

The key highlights of this study:

1. The American Heart Association (AHA), the European Society of Cardiology (ESC), the National Institute of Health and Care Excellence (NICE), and the Japanese Circulation Society (JCS) were evaluated as four appropriate clinical practice guidelines (CPGs); They scored 58%, 63%, 92%, and 71%, respectively, on the AGREE II initial overall evaluations (OA1).

2. In terms of OA1 (more than 70%), Domain [3] Rigor of Development (85%, 65%), and Domain [5] Applicability (76%, 48%), NICE and JCS received the highest scores.

3. The second overall evaluation (OA2) of the CPGs' utilization in routine practice showed no appreciable variation (recommended for use with modifications).

In conclusion, the Authors found that despite the potential for antimicrobial resistance, most CPGs favor antibiotic prophylaxis to avoid endocarditis following dental treatment are in favor of its usage.

Reference: i

Hussein, H., Montesinos-Guevara, C., Abouelkheir, M., Brown, R. S., Hneiny, L., & Amer, Y. S. (2022). Quality appraisal of antibiotic prophylaxis guidelines to prevent infective endocarditis following dental procedures: a systematic review. In Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. Elsevier BV. https://doi.org/10.1016/j.oooo.2022.07.012