An investigation of antibiotic prophylaxis in implant practice in the UK.

Oct 2012

Ireland RS, Palmer NO, Lindenmeyer A, Mills N.

Source

Warwick Dentistry, The University of Warwick, Coventry, CV4 7AL.

Abstract

Background: 

There is increasing evidence of the inappropriate use of antimicrobials in dentistry and this may contribute to the problem of antimicrobial resistance. The research to date with regard to efficacy of antimicrobial prophylaxis in reducing failure of integration and postoperative complications when placing dental implants remains equivocal. The aim of this study was to investigate how dentists in the UK use antimicrobials prophylactically in implant practice.

Method: 

An e-mail link was provided in 2011 to an anonymous online (Smart-Survey) questionnaire using three databases of dentists who, by being on them, had registered an interest in placing dental implants. Absolute frequencies were used to describe the study sample demographics and examine the distribution of responses for all the variables investigated.

Results:

 One hundred and nine completed questionnaires were received. Seventy-two percent (n = 76) routinely prescribed prophylactic antibiotics for all procedures. There was a wide variation in the pre-operative and postoperative prescription regimens with the majority (84%) stating that it was to prevent infection at the site of surgery or to reduce a bacteraemia.

Conclusions: 

Although this was a small study with a low response rate, wide variations in antibiotic prescribing regimens with respect to drug, dose and duration were found. Further research is needed and guidelines developed to prevent antibiotic over prescribing and misuse.

British Dental Journal

New British and American guidelines for the antibiotic prophylaxis of infective endocarditis: do the changes make sense? A critical review.

New British and American guidelines for the antibiotic prophylaxis of infective endocarditis: do the changes make sense? A critical review.

Curr Opin Infect Dis. 2008 Apr

Shanson D.
Department of Medical Microbiology, Great Ormond Street Hospital for Children, London, UK.

PURPOSE OF REVIEW: The British Society for Antimicrobial Chemotherapy and the American Heart Association have radically revised their guidelines for the antibiotic prophylaxis of endocarditis. This review discusses the evidence behind the most controversial changes and considers possible future developments.

RECENT FINDINGS: The new guidelines emphasize good oral hygiene for preventing viridans streptococcal endocarditis. Antibiotic prophylaxis for dental procedures is only recommended for patients with the highest-risk cardiac conditions. American Heart Association guidelines no longer recommend prophylaxis for urological and gastrointestinal procedures.

SUMMARY: While only up to 6% of endocarditis cases may be prevented by antibiotic prophylaxis there is controversy as to what to recommend for the individual cardiac patient undergoing a given procedure. The new guidelines about dental prophylaxis are based on epidemiological studies that failed to include sufficient subjects undergoing specific interventions. When considering viridans streptococcal rather than total bacteraemia rates, asserting that the prevalence of bacteraemia after invasive dental procedures is similar to that after toothbrushing may be incorrect. The British Society for Antimicrobial Chemotherapy report probably overestimates the risk of fatal anaphylaxis after an oral dose of amoxicillin. In contrast, the American Heart Association guidelines comment on the absence of any reports of fatal anaphylaxis associated with the antibiotic prophylaxis of endocarditis.

Lippincott, Williams & Wilkins