DT News - UK - SDCEP provides guidance for preventative antibiotic use

Dental Tribune UK

Mon. 27 August 2018

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LONDON, UK: In 2016, the National Institute for Health and Care Excellence’s CG64 clinical guideline (NICE CG64) was revised to include new guidance for dentists regarding the prophylactic use of antibiotics against infective endocarditis (IE). Following on from this, the Scottish Dental Clinical Effectiveness Programme (SDCEP) has recently published its own advice regarding the implementation of this prophylaxis in general dental practices.

Though SDCEP recommends that most patients at risk of IE should not receive antibiotic prophylaxis, it acknowledges that it should be considered for a small minority. IE is infection of the endocardium and the heart valves in particular. Though it is diagnosed in less than one in every 10,000 members of the general population each year, it comes with significant morbidity, and case fatality rates are around 30 per cent. For patients with a pre-existing heart condition, most cases of IE are caused by bacterial infections originating from transient bacteraemia.

For cases of IE originating from an oral source, bacteraemia was thought to mostly be produced by invasive dental procedures. As such, the use of antibiotic prophylaxis was widespread. It is now believed, however, that low-grade bacteraemia triggered by toothbrushing, dental flossing and other routine oral care activities is of a higher significance and that good oral hygiene, and not antibiotic prophylaxis, is more important in the prevention of IE.

“The vast majority of patients at increased risk of infective endocarditis will not be prescribed prophylaxis,” advises SDCEP in its guidance. “However, for a very small number of patients, it may be prudent to consider antibiotic prophylaxis (non-routine management) in consultation with the patient and their cardiologist or cardiac surgeon.”

The Faculty of General Dental Practice (UK) [FGDP(UK)], a professional membership body for practitioners in general dental practices, has endorsed these new guidelines.

“For over ten years, the recommendations in NICE CG64, which apply to all healthcare professionals, including cardiologists, have remained the same,” said Dr Nick Palmer, Fellow of the FGDP(UK). “These are that patients at increased risk of IE should be advised of the risks and benefits of prophylaxis, and that antibiotic prophylaxis is not routinely required for dental procedures. The patient should also be advised of the symptoms of IE, of the importance of maintaining good oral health to reduce their risk of IE, and when to seek expert advice.”

“SDCEP’s implementation advice shifts the balance of responsibility for the decision on antibiotic prophylaxis for these patients from the dentist to the patient’s cardiologist and to the patient under Montgomery consent. Dentists should ensure they record in the clinical notes any advice from the patient’s cardiologist and the patient’s consent when a decision is made,” he continued.

SDCEP’s implementation advice, titled Antibiotic Prophylaxis Against Infective Endocarditis, can be found here.

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