Penicillins for the prophylaxis of bacterial endocarditis in dentistry

Abstract

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.

Antibiotic prophylaxis in oral healthcare – the agreement between Swedish recommendations and evidence

“…This conclusion is in accordance with the results of the systematic reviews by Oliver et al, 6 Lockhart et al, 9 NICE 7 and Oliver et al 8 However, in the study by van der Meer et al 15 patients with prosthetic heart valves were not included. This means that we cannot dismiss the possibility that there could be a signifi cant protective effi cacy for this group of patients.…”

Antibiotic prophylaxis in oral healthcare – the agreement between Swedish recommendations and evidence

“…This conclusion is in accordance with the results of the systematic reviews by Oliver et al, 6 Lockhart et al, 9 NICE 7 and Oliver et al 8 However, in the study by van der Meer et al 15 patients with prosthetic heart valves were not included. This means that we cannot dismiss the possibility that there could be a signifi cant protective effi cacy for this group of patients.…”

Endocarditis Pathogen Promotes Vegetation Formation by Inducing Intravascular Neutrophil Extracellular Traps Through Activated Platelets

“…Prophylaxis with antibiotics for the prevention of IE is recommended by the American Heart Association, 20 but the efficacy remains controversial. [21][22][23] Our previous and current data also showed that prophylaxis with penicillin alone could not completely block vegetation formation because of the deep-seated bacteria-platelet aggregates entrapped in NETs ( Figure III in the online-only Data Supplement). 16 Prophylactic administration of DNase I together with penicillin significantly reduced the size of the vegetation, the number of colonized bacteria in the vegetation, and the severity of bacteremia ( Figure III in the online-only Data Supplement).…”

Endodontics and infective endocarditis – is antimicrobial chemoprophylaxis required?

“…Because of the increasing evidence that spontaneous bacteraemia is more likely to cause IE than dental procedures (Seymour et al 2000), the importance of soft tissue health as a prophylactic measure for IE cannot be overstated (Lavelle 1996). Ethically, practitioners need to discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about antibiotic administration (Oliver et al 2004). There is a problem in that practitioners feel that they are bound by current guidelines and medico-legal considerations, to provide antibiotic prophylaxis, rather than to make decisions based on best evidence.…”

Antibiotic prophylaxis in oral healthcare – the agreement between Swedish recommendations and evidence

“…This conclusion is in accordance with the results of the systematic reviews by Oliver et al, 6 Lockhart et al, 9 NICE 7 and Oliver et al 8 However, in the study by van der Meer et al 15 patients with prosthetic heart valves were not included. This means that we cannot dismiss the possibility that there could be a signifi cant protective effi cacy for this group of patients.…”

Endocarditis Pathogen Promotes Vegetation Formation by Inducing Intravascular Neutrophil Extracellular Traps Through Activated Platelets

“…Prophylaxis with antibiotics for the prevention of IE is recommended by the American Heart Association, 20 but the efficacy remains controversial. [21][22][23] Our previous and current data also showed that prophylaxis with penicillin alone could not completely block vegetation formation because of the deep-seated bacteria-platelet aggregates entrapped in NETs ( Figure III in the online-only Data Supplement). 16 Prophylactic administration of DNase I together with penicillin significantly reduced the size of the vegetation, the number of colonized bacteria in the vegetation, and the severity of bacteremia ( Figure III in the online-only Data Supplement).…”

Endodontics and infective endocarditis – is antimicrobial chemoprophylaxis required?

“…Because of the increasing evidence that spontaneous bacteraemia is more likely to cause IE than dental procedures (Seymour et al 2000), the importance of soft tissue health as a prophylactic measure for IE cannot be overstated (Lavelle 1996). Ethically, practitioners need to discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about antibiotic administration (Oliver et al 2004). There is a problem in that practitioners feel that they are bound by current guidelines and medico-legal considerations, to provide antibiotic prophylaxis, rather than to make decisions based on best evidence.…”

Antibiotic prophylaxis in oral healthcare – the agreement between Swedish recommendations and evidence

“…This conclusion is in accordance with the results of the systematic reviews by Oliver et al, 6 Lockhart et al, 9 NICE 7 and Oliver et al 8 However, in the study by van der Meer et al 15 patients with prosthetic heart valves were not included. This means that we cannot dismiss the possibility that there could be a signifi cant protective effi cacy for this group of patients.…”

Endocarditis Pathogen Promotes Vegetation Formation by Inducing Intravascular Neutrophil Extracellular Traps Through Activated Platelets

“…Prophylaxis with antibiotics for the prevention of IE is recommended by the American Heart Association, 20 but the efficacy remains controversial. [21][22][23] Our previous and current data also showed that prophylaxis with penicillin alone could not completely block vegetation formation because of the deep-seated bacteria-platelet aggregates entrapped in NETs ( Figure III in the online-only Data Supplement). 16 Prophylactic administration of DNase I together with penicillin significantly reduced the size of the vegetation, the number of colonized bacteria in the vegetation, and the severity of bacteremia ( Figure III in the online-only Data Supplement).…”

Endodontics and infective endocarditis – is antimicrobial chemoprophylaxis required?

“…Because of the increasing evidence that spontaneous bacteraemia is more likely to cause IE than dental procedures (Seymour et al 2000), the importance of soft tissue health as a prophylactic measure for IE cannot be overstated (Lavelle 1996). Ethically, practitioners need to discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about antibiotic administration (Oliver et al 2004). There is a problem in that practitioners feel that they are bound by current guidelines and medico-legal considerations, to provide antibiotic prophylaxis, rather than to make decisions based on best evidence.…”