# A Review of Guidelines for Antibiotic Prophylaxis before Invasive Dental Treatments
## 2 Materials and Methods
### Review of Guidelines
#### 2.1.3 Guidelines for Antibiotic Prophylaxis Regimens  
Antibiotic prophylaxis regimens also vary among different regions of world. There is similarity in the recommendations between the \"European Society of Endodontology (ESE) position statement on the use of antibiotics in endodontics\" [25] and \"The antibiotic Prophylaxis 2017 Update\" recommendations by the American Association of Endodontists (AAE) [22], which is based on the 2017 American Heart Association and American College of Cardiology focused update of the 2014 AHA/ADA Guideline (Table 5). The British National Formulary (BNF) [27] lacks information on prophylactic antibiotics for infective endocarditis in dentistry. The SDCEP Antibiotic Prophylaxis Against Infective Endocarditis--Implementation Advice [8] recommends regimens for adults based on the 2006 British Society for Antimicrobial Chemotherapy report [28], while the doses for children are based on the 2015 ESC guidelines [6]. There is a difference between the SDCEP antibiotic prophylaxis regimen and the ESE, AAE and KCE report 332 recommendations (Table 5). \begin{table}
\begin{tabular}{c c c c c c} \hline \hline \multicolumn{3}{c}{**European Society of Endodontology Position Statement: The Use of Antibiotics in Endodontics [25]**} \\ \hline \hline
**Patient group** & **Antibiotic** & **Route** & **Adult** & **Child** & **Timing before** \\ General prophylaxis & Amoxicillin & PO & 2 g & 50 mg/kg & 1 h \\ Unable to take oral medication & Ampicillin & IV or IM & 2 g & 50 mg/kg & Within 30 min \\ \multirow{6}{*}{Allergic to penicillin} & \(\bullet\) & Clindamycin & & & \\ \cline{1-1}  & \(\bullet\) & Cephalexin or & & & \\ \cline{1-1}  & \(\bullet\) & cefadroxil & & 600 mg & 20 mg/kg & \\ \cline{1-1}  & \(\bullet\) & PO & 2 g & 50 mg/kg & 1 h \\ \cline{1-1}  & & Clarithromycin or & & 500 mg & 15 mg/kg & \\ \cline{1-1}  & & azithromycin & & &  
The World Health Organisation has emphasised the emergence of microbes with antibiotic resistance. In this regard, it is suggested that if the patient is recommended for antibiotic prophylaxis and is already taking an antibiotic, the clinician should choose an antibiotic from a different class; for example, for a patient already receiving oral penicillin for another condition, beta-lactams-resistant viridans group streptococci are more likely  
\begin{table}
\begin{tabular}{p{113.8 pt} p{113.8 pt} p{113.8 pt} p{113.8 pt} p{113.8 pt} p{113.8 pt} p{113.8 pt}} \hline \hline \multicolumn{6}{c}{**European Society of Endodontology Position Statement: The Use of Antibiotics in Endodontics [25]**} \\ \hline  & & Cephalexin (or other first- or second-generation oral allergy to penicillin or ampicillin in capitulant) &  
to be present in the oral cavity, therefore antibiotic from a different class needs to be prescribed for effective prophylaxis [8; 22]. In order to encourage best practices, policy makers should make unanimous guidelines globally regarding the drugs, their doses and specific indications to avoid further emergence and spread of antibiotic resistance. Since at present there are variations in the antibiotic prophylaxis indications and regimens among different guidelines, it is important that these should be discussed in detail with high-risk patients as part of the informed consent prior to any invasive dental treatment, such as endodontic treatment, periodontal treatment and so forth, and the outcome of the discussion should be recorded in patient notes. This would give the patient the opportunity to make an informed decision prior the commencement of invasive dental procedures. 1.4 Guidelines for Timing of Dental Screening, Treatment and Favourable Outcome before Invasive Cardiovascular Surgery  
The timing of dental screening for oral disease, its treatment and favourable outcome before commencement of cardiovascular surgery is critical. This could significantly reduce the risk of infective endocarditis and systemic inflammatory burden that can trigger vascular events.