Amid international debate about the necessity of prophylactic antibiotics for patients at elevated risk for infective endocarditis (IE) who are having invasive dental procedures, a new observational study indicates a lower likelihood of IE occurrence among such patients who take antibiotics before surgery.
While uncommon, IE—a heart infection caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve, or a blood vessel—is more likely present in patients with heart valve disease or previous valve surgery, congenital heart disease, or recurrent infective endocarditis.
The new study, published in the Journal of the American College of Cardiology, may affirm guidelines set out by the AHA that more tightly defined the subgroup of patients who should receive preventive antibiotics before certain dental procedures to four high-risk categories: those with prosthetic heart valves or prosthetic material used for valve repair; those who have had a previous case of infective endocarditis; adults and children with congenital heart disease; or people who have undergone a heart transplant.
Medical History Mysteries: New AHA guidelines for antibiotic prophylaxis
The data from the new observational study “validates that recommendation,” lead author Martin H. Thornhill, MBBS, BDS, PhD, told TCTMD, a publication of Cardiovascular Research Foundation (CRF). Previously, “the problem has been although these guidelines exist, there really hasn’t been any hard evidence to support the guidance, neither in terms of there being a clear association between invasive dental procedures and endocarditis, nor in terms of the efficacy of antibiotic prophylaxis.”
According to study researchers, results “demonstrated a significant temporal association between IDPs (particularly extractions and oral-surgical procedures) and subsequent IE in high–IE-risk individuals, and a significant association between AP use and reduced IE incidence following these procedures.”
Thornhill told TCTMD that he hopes the study is sufficient to sway practice, as currently only a third of high-risk patients in the data set received antibiotic prophylaxis prior to their procedures.
An internationally debated issue
In April 2021, the American Heart Association (AHA) released a scientific statement indicating that good oral hygiene and regular dental care are the most important ways to reduce risk IE and that “maintenance of good oral health is more important than use of antibiotics in dental procedures for some heart patients to prevent a heart infection caused by bacteria around the teeth,” also affirming previous recommendations about the four categories of heart patients who should be prescribed antibiotics before certain dental procedures.
In February 2022, a 10-year study from Sweden, one of the few countries to have removed recommendations to give prophylactic antibiotics to people at a higher risk of IE, indicated that there’s been no discernible uptick in IE since nixing the practice, with researchers acknowledging that “this is an internationally debated issue and Sweden and the UK are the only countries in Europe to restrict antibiotic use like this."
