Antibiotic prophylaxis before dental procedures to prevent infective endocarditis: a systematic review

Abstract

Purpose: Infective endocarditis (IE) is a severe bacterial infection. As a measure of prevention, the administration of antibiotic prophylaxis (AP) prior to dental procedures was recommended in the past. However, between 2007 and 2009, guidelines for IE prophylaxis changed all around the word, limiting or supporting the complete cessation of AP. It remains unclear whether AP is effective or not against IE.

Methods: We conducted a systematic review whether the administration of AP in adults before any dental procedure, compared to the non-administration of such drugs, has an effect on the risk of developing IE. We searched for studies in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via OVID, and EMBASE. Two different authors filtered articles independently and data extraction was performed based on a pre-defined protocol.

Results: The only cohort study meeting our criteria included patients at high-risk of IE. Analysis of the extracted data showed a non-significant decrease in the risk of IE when high-risk patients take AP prior to invasive dental procedures (RR 0.39, p-value 0.11). We did not find other studies including patients at low or moderate risk of IE. Qualitative evaluation of the excluded articles reveals diversity of results and suggests that most of the state-of-the-art articles are underpowered.

Conclusions: Evidence to support or discourage the use of AP prior to dental procedures as a prevention for IE is very low. New high-quality studies are needed, even though such studies would require big settings and might not be immediately feasible.

Keywords: Antibiotic prophylaxis prior dental procedure; Dental procedure; Endocarditis guidelines; Endocarditis prophylaxis; High-risk patients; Infective endocarditis.

Fig. 1

A Literature search and filtering process. Numbers correspond to studies under consideration at each step. Green shows the final number of publications that met our inclusion criteria. Blue shows the number of publications for which we clearly describe the reason of inclusion/exclusion. B Contingency table for the included publication. C Plot of the effects of AP in the risk ratio of developing IE based on one publication