Use of Antibiotic Prophylaxis for Tooth Extractions, Dental Implants and Periodontal Surgical Procedures

Abstract

BackgroundGuidelines for dental procedure antibiotic prophylaxis have changed significantly, reducing the number of patients indicated to receive antibiotics. The primary objective was to determine the frequency and appropriateness of dental antibiotic prophylaxis at a VA dental clinic.MethodsThis was a cross-sectional study of patients undergoing tooth extractions, dental implants and periodontal procedures in 2015. These procedures are among the most common procedures with the potential for bacteremia post-dental procedure. Patients receiving antibiotics for a separate oral or non-oral infection on the date of the dental procedure were excluded.ResultsOf 183 Veterans undergoing the included dental procedures, 82.5% received antibiotic prophylaxis. Amoxicillin (71.3% of antibiotics) and clindamycin (23.8%) were prescribed most frequently; 44.7% of clindamycin was prescribed to patients not labeled as penicillin allergic. The mean duration of antibiotics was 7.1 +/- 1.6 (1–14) days; 82.5% receiving seven days supply. Of those that received antibiotic prophylaxis, 92.1% received post-procedure antibiotics only, 2.6% pre-procedural antibiotics only and 5.3% received pre- and post-procedure antibiotics. When prophylaxis was indicated (procedure and/or cardiac condition), 85.3% received an antibiotic. However, 72.7% received post-procedure antibiotics when only pre-procedure administration was indicated. When pre-procedure antibiotics were indicated, 11.5% did not receive any antibiotics (pre- or post-procedure). Only 8.2% received antibiotics appropriately based on administration time, procedure and co-morbidities. Three months post-procedure, there were no occurrences of Clostridium difficile, infective endocarditis, prosthetic joint infections or oral infections.ConclusionThe majority of patients undergoing a dental procedure received antibiotic prophylaxis. While the majority of these antibiotics were indicated pre-procedure, prescribing of post-procedure antibiotic for excessive durations was frequent. Dental stewardship efforts should ensure appropriate timing, indications, and duration of antibiotic prophylaxis.Disclosures All authors: No reported disclosures.

Prescribing practices for antibiotic prophylaxis in patients with prosthetic joints

“…As mentioned above, the majority of providers still recommend AP for the first 2 years, with some still recommending lifelong prescriptions, which is not consistent with the 2015 ADA nor the AUC tool. The findings in this study are consistent with other publications …”

Associação entre endocardite bacteriana e procedimento de cirurgia e traumatologia bucomaxilofacial

“…Bacteremias transitórias podem ocorrer, por sua vez, mesmo na ausência de procedimentos odontológicos frente à higienização dental ou periodontal inadequada, assim como infecções periapicais, periodontais e da mucosa bucal. Por isso, muitos autores defendem que o risco estimado de EI relacionado a procedimentos odontológicos esporádicos é baixo [4][5][6][7] .…”

“…Entre as características clínicas observadas em pacientes com EI estão febre alta, perda de peso, letargia, dificuldade respiratória, sopros cardíacos novos, fenômenos imunológicos, manifestações cutâneas como os nódulos de Osler e as lesões de Janeway. Entre as principais complicações estão incluídas sepse, acidente vascular cerebral e insuficiência cardíaca por disfunção valvar 4,7,8 .…”

“…O julgamento clínico a partir da história e do exame clínico do paciente é fundamental para o diagnóstico das endocardites, confirmado com o auxílio de exames complementares e achados histológicos e microbiológicos de hemoculturas positivas para bactérias específicas da EI 4 [7][8][9][10] .…”

“…Toda estrutura em suporte básico de vida que dispomos e diversas tecnologias para diagnóstico, hoje parecem não ser suficientes, uma vez que índices de mortalidade por endocardite infecciosa alcançam cerca de 25% 3 . Nos dias atuais, as discussões acerca da Cirurgia e Traumatologia Bucomaxilofacial (CTBMF) e da endocardite infecciosa, decorrente da microbiota oral envolvida nesses procedimentos cirúrgicos, buscam esclarecer o tipo de tratamento disponível para a doença, e principalmente, as manobras a serem tomadas visando sua prevenção 4 .…”