Cahill TJ, Harrison JL, Jewell P, Onakpoya I, Chambers JB, Dayer M, Lockhart P, Roberts N, Shanson D, Thornhill M, Heneghan CJ, Prendergast BD.
Heart. 2017 Jun;103(12):937-944. doi: 10.1136/heartjnl-2015-309102. Epub 2017 Feb 17.
The use of antibiotic prophylaxis (AP) for prevention of infective endocarditis (IE) is controversial. In recent years, guidelines to cardiologists and dentists have advised restriction of AP to high-risk groups (in Europe and the USA) or against its use at all (in the UK). The objective of this systematic review was to appraise the evidence for use of AP for prevention of bacteraemia or IE in patients undergoing dental procedures.
We conducted electronic searches in Medline, Embase, Cochrane Library and ISI Web of Science. We assessed the methodological characteristics of included studies using the Strengthening the Reporting of Observational Studies in Epidemiology criteria for observational studies and the Cochrane Risk of Bias Tool for trials. Two reviewers independently determined the eligibility of studies, assessed the methodology of included studies and extracted the data.
We identified 178 eligible studies, of which 36 were included in the review. This included 10 time-trend studies, 5 observational studies and 21 trials. All trials identified used bacteraemia as an endpoint rather than IE. One time-trend study suggests that total AP restriction may be associated with a rising incidence of IE, while data on the consequences of relative AP restriction are conflicting. Meta-analysis of trials indicates that AP is effective in reducing the incidence of bacteraemia (risk ratio 0.53, 95% CI 0.49 to 0.57, p
Inconclusive evidence on using antibiotic prophylaxis before dental procedures to prevent infective endocarditis
Mohamed-Nur Abdallah, BDS, MSc, PhD
Systematic Review Conclusion
Despite the limited evidence and poor methodological quality of many included studies, antibiotic prophylaxis (AP) for patients at highest risk of developing infective endocarditis (IE) is a pragmatic and justified approach. However, postprocedural bacteremia may not be a good surrogate end point for IE.
Critical Summary Assessment
This systematic review found limited evidence that was compromised by many heterogeneous studies with poor methodological quality. Based on the available evidence, no definite conclusion can be reached on the efficacy of AP in preventing IE in patients undergoing dental procedures.
Evidence Quality Rating
This summary is published in the Journal of the American Dental Association and can be accessed at:
Critical Summary Publication Date:
These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association © 2019