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Lookup NU author(s): Emeritus Professor Robin Seymour
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DATA SOURCES: Cochrane Oral Health, Heart and Infectious Diseases Groups' Trials Registers Cochrane Central Register of Controlled Trials (CENTRAL) OLDMEDLINE; EMBASE SIGLE (to June 2002); and the Meta-register of current controlled trials. STUDY SELECTION: Due to the low incidence of BE a low yield of trials was expected so cohort and case-controlled studies were included where suitably matched control or comparison groups had been studied. The intervention was the administration of penicillin compared to no such administration before a dental procedure in people with an increased risk of BE. Outcomes of interest were: mortality or serious adverse event requiring hospital admission; development of endocarditis following any dental procedure in a defined time period; development of endocarditis due to other non-dental causes; any recorded adverse events to the antibiotics; and cost implications of the antibiotic provision for the care of those patients who develop endocarditis. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently selected studies for inclusion, then assessed quality and extracted data from the included study. RESULTS: One case-control study met the criteria. This study included participants who died because of the endocarditis (using proxys). It collected all the cases of endocarditis in the Netherlands over 2 years, finding 24 people who developed endocarditis within 180 days of an invasive dental procedure. Controls attended local cardiology outpatient clinics for similar cardiac problems, had undergone an invasive dental procedure within the past 180 days and were matched by age with the cases. No significant effect of penicillin prophylaxis on the incidence of endocarditis could be seen. No data were found on other outcomes. CONCLUSIONS: There is no evidence about whether penicillin prophylaxis is effective or ineffective against bacterial endocarditis in people at risk who are about to undergo an invasive dental procedure. There is a lack of evidence to support published guidelines in this area. It is not clear whether the potential harms and costs of penicillin administration outweigh any beneficial effect. Ethically practitioners need to discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about administration.
Author(s): Seymour R
Publication type: Note
Publication status: Published
Journal: Evidence-Based Dentistry
Year: 2004
Volume: 5
Issue: 2
Pages: 46
ISSN (print): 1462-0049
ISSN (electronic): 1476-5446
URL: http://dx.doi.org/10.1038/sj.ebd.6400258
DOI: 10.1038/sj.ebd.6400258
