"Infective endocarditis is a rare but serious infection of the heart lining. We hope that our data will provide the information that guideline committees need to re-evaluate the benefits, or not, of giving antibiotic prophylaxis," says Martin Thornill. (Credit: Conor Lawless/Flickr)

antibiotics

Who should get antibiotics before the dentist?

As fewer people in the UK get preventative antibiotics for trips to the dentist, scientists are seeing a significant rise in the number of people diagnosed with a serious heart infection.

A new study is the largest and most comprehensive yet with regards to the UK’s National Institute for Health and Care Excellence (NICE) guidelines, which recommended dentists should no longer give antibiotics before invasive treatments to people considered at risk of the life threatening heart infection known as infective endocarditis (IE).

Bacteria from the mouth cause 40 percent of IE cases.

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Researchers led by Professor Martin Thornhill of the University of Sheffield’s School of Clinical Dentistry discovered that since the new guidelines were introduced in March 2008 there has been an increase in cases of infective endocarditis above the expected trend.

By March 2013 this accounted for an extra 35 cases each month.

The team also reports that the prescribing of antibiotic prophylaxis fell by 89 percent from 10,900 prescriptions a month, before the 2008 guidelines, to 1,235 a month by March 2008.

“Infective endocarditis is a rare but serious infection of the heart lining. We hope that our data will provide the information that guideline committees need to re-evaluate the benefits, or not, of giving antibiotic prophylaxis,” says Thornill, professor of translational research in dentistry.

Thornhill stresses that healthcare professionals and patients should wait for the guideline committees to evaluate the evidence and give their advice before changing their current practice.

“In the meantime, healthcare professionals and patients should focus on maintaining high standards of oral hygiene. This will reduce the number of bacteria in the mouth which have the potential to cause infective endocarditis and reduce the need for invasive dental procedures to be performed.”

Researchers from the University of Sheffield, Oxford University Hospitals NHS Trust, Taunton and Somerset NHS Trust, and the University of Surrey in the UK, as well as from the Mayo Clinic and the Carolinas HealthCare System’s Carolinas Medical Center in the US, appears in The Lancet. There will also be a presentation at the American Heart Association annual meeting in Chicago.

Heart Research UK, healthcare provider Simplyhealth, and the National Institute for Dental and Craniofacial Research supported the work.

Source: University of Sheffield

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