Antibiotics for Prevention of Endocarditis during Dentistry: Time To Scale Back?
Authors: David T. Durack
Journal: Annals of Internal Medicine (1998)

Editorials15 November 1998Antibiotics for Prevention of Endocarditis during Dentistry: Time To Scale Back?David T. Durack, MB, DPhilDavid T. Durack, MB, DPhilBecton Dickinson Microbiology Systems; Baltimore, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-129-10-199811150-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Antibiotics should be given to prevent endocarditis when a predisposed patient undergoes dental treatment. This 50-year-old doctrine is based on a logical premise: Dental procedures induce bacteremias with bacterial species that often cause endocarditis, and endocarditis carries high morbidity and mortality; therefore, antibiotics should be administered to susceptible patients before dental procedures to prevent endocarditis [1]. Furthermore, antibiotics definitely can prevent endocarditis in experimental animals [1-3]. On these grounds, prophylaxis against endocarditis is widely recommended [1, 4]. Although compliance has been less than perfect [5] and apparent failures of prophylaxis are not rare [6], the practice is now so entrenched ...References1. Durack DT. Prevention of infective endocarditis. N Engl J Med. 1995; 332:38-44. Google Scholar2. Moreillon P, Francioli P, Overholser D, Meylan P, Glauser MP. Mechanisms of successful amoxicillin prophylaxis of experimental endocarditis due to Streptococcus intermedius. J Infect Dis. 1986; 154:801-7. Google Scholar3. Malinverni R, Francioli PB, Glauser MP. Comparison of single and multiple doses of prophylactic antibiotics in experimental streptococcal endocarditis. Circulation. 1987; 76:376-82. Google Scholar4. Dajani AS, Taubert KA, Wilson W, Bolger AF, Bayer A, Ferrieri P, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. Circulation. 1997; 96:358-66. Google Scholar5. van der Meer JT, Van Wijk W, Thompson J, Valkenburg HA, Michel MF. Awareness of need and actual use of prophylaxis: lack of patient compliance in the prevention of bacterial endocarditis. J Antimicrob Chemother. 1992; 29:187-94. Google Scholar6. Durack DT, Kaplan EL, Bisno AL. Apparent failures of endocarditis prophylaxis. Analysis of 52 cases submitted to a national registry. JAMA. 1983; 250:2318-22. Google Scholar7. Martin MV, Butterworth ML, Longman LP. Infective endocarditis and the dental practitioner: a review of 53 cases involving litigation. Br Dent J. 1997; 182:465-8. Google Scholar8. Guntheroth WG. How important are dental procedures as a cause of infective endocarditis? Am J Cardiol. 1984; 54:797-801. Google Scholar9. Clemens JD, Ransohoff DF. A quantitative assessment of pre-dental antibiotic prophylaxis for patients with mitral-valve prolapse. J Chronic Dis. 1984; 37:531-44. Google Scholar10. van der Meer JT, Thompson J, Valkenburg HA, Michel MF. Epidemiology of bacterial endocarditis in The Netherlands. II. Antecedent procedures and use of prophylaxis. Arch Intern Med. 1992; 152:1869-73. Google Scholar11. Wahl MJ. Myths of dental-induced endocarditis. Arch Intern Med. 1994; 154:137-44. Google Scholar12. Bor DH, Himmelstein DU. Endocarditis prophylaxis for patients with mitral valve prolapse. A quantitative analysis. Am J Med. 1984; 76:711-7. Google Scholar13. Pallasch TJ. A critical appraisal of antibiotic prophylaxis. Int Dent J. 1989; 39:183-96. Google Scholar14. van der Meer JT, Van Wijk W, Thompson J, Vandenbroucke JP, Valkenburg HA, Michel MF. Efficacy of antibiotic prophylaxis for prevention of native-valve endocarditis. Lancet. 1992; 339:135-9. Google Scholar15. Strom BL, Abrutyn E, Berlin JA, Kinman JL, Feldman RS, Stolley PD, et al. Dental and cardiac risk factors for infective endocarditis. A population-based, case–control study. Ann Intern Med. 1998; 129:761-9. Google Scholar16. Starkebaum M, Durack D, Beeson P. The "incubation period" of subacute bacterial endocarditis. Yale J Biol Med. 1977; 50:49-58. Google Scholar17. Sale L. Some tragic results following extraction of teeth. II. J Am Dent Assoc. 1939; 26:1647-51. Google Scholar18. Okell CC, Elliott SD. Bacteriaemia and oral sepsis with special reference to the etiology of subacute endocarditis. Lancet. 1935; 2:869-72. Google Scholar19. Doern GV, Ferraro MJ, Brueggemann AB, Ruoff KL. Emergence of high rates of antimicrobial resistance among viridans group streptococci in the United States. Antimicrob Agents Chemother. 1996; 40:891-4. Google Scholar20. Dowson CG, Coffey TJ, Kell C, Whiley RA. Evolution of penicillin resistance in Streptococcus pneumoniae: the role of Streptococcus mitis in the formation of a low affinity PBP2B in S. pneumoniae. Mol Microbiol. 1993; 9:635-43. Google Scholar Author, Article, and Disclosure InformationAuthors: David T. Durack, MB, DPhilAffiliations: Becton Dickinson Microbiology Systems; Baltimore, MDCorresponding Author: David T. Durack, MB, DPhil, Becton Dickinson Microbiology Systems, 7 Loveton Circle, Sparks, MD 21152-0999. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDental and Cardiac Risk Factors for Infective Endocarditis: A Population-Based, Case-Control Study Brian L. Strom , Elias Abrutyn , Jesse A. Berlin , Judith L. Kinman , Roy S. Feldman , Paul D. Stolley , Matthew E. Levison , Oksana M. Korzeniowski , and Donald Kaye Metrics Cited byAntibiotics for prevention of endocarditis: time to scale up? Not yet!Adapted from: Prevention of Viridans Group Streptococcal Infective EndocarditisInvasive dental procedures as risk factors for postoperative spinal infection and the effect of antibiotic prophylaxisPrevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart AssociationImpact of AHA's 2007 guideline change on incidence of infective endocarditis in infants and childrenProphylaxis of EndocarditisInfective Endocarditis Prophylaxis and PreventionProphylaxis of Infective EndocarditisInfective EndocarditisInfective endocarditis prophylaxis: moving from dental prophylaxis to global prevention?Temporal Trends in Infective Endocarditis in the Context of Prophylaxis Guideline ModificationsEndocarditis infecciosaPeriodontal Treatment of Medically Compromised PatientsNew guidelines and the development of an international consensus on recommendations for the antibiotic prophylaxis of infective endocarditisThe prophylaxis of infective endocarditis: a joint position study of the Italian Federation of Cardiologists and the Italian Society of Infectious and Tropical DiseasesPrevention of Infective EndocarditisKnowledge and practices of dentists in preventing infective endocarditis in childrenInfective endocarditis and antibiotic prophylaxis prior to dental/oral procedures: latest revision to the guidelines by the American Heart Association published April 2007Are dental procedures an important risk factor for infective endocarditis? 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Bartlett, MDTrials of the use of antimicrobial agents in cardiovascular diseasesInfective endocarditis: Current guidelines on prophylaxisThe Need for Antibiotic Prophylaxis during Peritoneal DialysisNew Insights and Updates for Established EntitiesCardiovascular Disease in Pregnancy 15 November 1998Volume 129, Issue 10Page: 829-831KeywordsAntibiotic prophylaxisAntibioticsBacteremiaCardiac surgeryChildrenEndocarditisHealth care providersInfectious diseasesMitral valve prolapseProphylaxis ePublished: 15 August 2000 Issue Published: 15 November 1998 Copyright & PermissionsCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...