The National Institute for Health and Care Excellence (NICE) is being urged to review dental antibiotic prophylaxis guidelines to protect those at high risk of developing a serious heart infection.
Research led by the University of Sheffield has found that dental patients at high risk of infective endocarditis, a life-threatening infection of the heart valves that causes heart failure and strokes, should receive antibiotics before undergoing invasive treatments such as extractions or oral surgery. . This latest study provides further evidence that current UK guidelines may be putting high-risk patients at unnecessary extra risk when undergoing invasive dental procedures.
Infective endocarditis (IE) is a serious heart infection that can be fatal – 30% of people will die within a year of diagnosis. In around 30% to 40% of cases it is caused by bacteria that come from the mouth, either due to poor oral hygiene or during invasive dental procedures.
To avoid this, patients at highest risk for IE – those who have undergone cardiac interventions such as heart valve prosthetics, valve repairs, and congenital heart disease repairs – were recommended to have antibiotic prophylaxis (AP) coverage before undergoing IE. invasive dental treatment.
However, in 2008, NICE recommended against using antibiotic prophylaxis (AP) due to a lack of evidence of effectiveness and concerns about the possibility of adverse reactions to the antibiotics used.
Although guideline committees around the world had similar concerns, they continued to recommend PA for patients most at risk of developing IE because they felt that the risks of developing IE far outweighed any risks of giving PA to this group of patients.
Despite considerable new evidence that AP is safe, effective and would result in significant cost savings and health benefits, NICE has not revised its recommendation against the use of AP since 2015.
A new study led by the University of Sheffield School of Dental Medicine, in collaboration with Professor Bernard Prendergast – Consultant Cardiologist at St Thomas’ Hospital and Cleveland Clinic, London, UK; Professor Mark Dayer — Consultant Cardiologist, Cardiovascular Research Institute, Dublin, Ireland; Ash Frisby—Endocarditis Patient Advocate, and Professor Larry Baddour—Professor of Medicine (Infectious Diseases), Mayo Clinic College of Medicine, Rochester, MN, USA, was published in The Lancet Regional Health – Europe
The study found:
The risk of IE in high-risk patients after invasive dental procedures as a whole is 1 in 1,000—this drops to 1 in 3,333 if BP is administered before the procedure.
The risk of IE in high-risk patients after extractions is 1 in 100—this drops to 1 in 1,000 if PA is used.
The risk of IE after oral surgery is 1 in 40 — this drops to 1 in 500 if PA is used.
In contrast, the risk of a significant adverse reaction after amoxicillin AP is only 1 in 250,000 prescriptions, and none of them would be fatal, while 3 in 10 people with IE would die within a year.
Professor Martin Thornhill, from the University of Sheffield’s School of Dental Medicine and lead author of the study, said: “Infective endocarditis is a rare but devastating heart infection, in which around 30% of people die in the first year after their development.
“All major guideline committees around the world, such as the American Heart Association and the European Society of Cardiology, recommend that those at high risk for infective endocarditis should receive antibiotic prophylaxis before undergoing invasive dental procedures.
We urge NICE to review its guidance so that high-risk patients in the UK receive the same protection against EI as patients elsewhere in the world.
“There are currently 400,000 people at high risk of developing IE in the UK and this number is rising every year due to the increasing number of patients having cardiac interventions.
“Our previous study showed that prescribing antibiotic prophylaxis would be cost-effective if it prevented just 1.4 high-risk patients per year from developing infective endocarditis. Therefore, by preventing between 40 and 260 cases per year, antibiotic prophylaxis would be highly cost-effective and would likely save the NHS more than £5.5 million annually, as well as generating substantial health gains for those at risk of endocarditis.”
Professor Thornhill and the international team of researchers and cardiologists have carried out a series of studies over the last 10 years, the first of which identified a significant increase in the number of people diagnosed with the serious heart infection, along with a large drop in the prescription of antibiotic prophylaxis for dental patients.
Source: University of Sheffield / MedicalXpress
Photo: Unsplash/CCO Public Domain
Tags: Dental Medicine Guidelines Antibiotics
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