UK dentists should be encouraged to give antibiotics to patients at high risk of life-threatening heart infection before invasive procedures, a study has found.
Research suggests that bacteria from the mouth entering the bloodstream during dental treatment could account for 30% to 40% of cases of infective endocarditis. The rare but life-threatening condition occurs when the inner lining of the heart’s chambers and valves become infected.
According to the study, antibiotics could limit the number of cases and reduce the risk of heart failure, stroke and premature death in high-risk patients.
Current guidelines from the National Institute for Health and Care Excellence (Nice) advise against the routine use of antibiotics before invasive dental procedures for those at risk of infective endocarditis.
“Ours is the largest study to show a significant association between invasive dental procedures and infective endocarditis, particularly for extraction and surgical procedures,” said Professor Martin Thornhill of the University of Sheffield, who direct the study.
NICE should revise its guidelines that advise against antibiotic prophylaxis, the researchers said.
Guidelines committees in other countries, including the American Heart Association and the European Society of Cardiology, recommend antibiotics for high-risk patients.
“The data strongly validates the guidelines of almost every committee around the world, especially the American Heart Association, that recommend antibiotic prophylaxis for high-risk patients,” Thornhill said.
The team analyzed the medical, dental and prescription records of nearly 8 million people in the US. Almost 37,000 participants were at high risk for endocarditis.
The risk of infective endocarditis was 10 times lower in high-risk patients who took antibiotics before dental extractions compared with those who did not, and 12.5 times lower before surgical procedures.
“We were able to compare people at high risk who received antibiotic prophylaxis and those who did not, and we clearly showed a lower risk of infection after invasive procedures with antibiotics,” Thornhill said.
Good guidance should be updated and clarified, Thornhill said: “The guidance is simply not clear. The wording is very ambiguous and leaves open the question of whether particular patients should receive antibiotic prophylaxis.
“The current study provides the evidence needed to have discussions with patients about the risks and for dentists to recommend antibiotics when necessary,” added Thornhill.
A spokesman for Nice said: “Nice takes a proactive approach to updating its guidelines, including reacting to and considering any new evidence and its potential to affect current recommendations.”
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