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Dental Aspects of Endocarditis Prophylaxis |
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Determine the cardiac risk from Table 1. If the risk is Moderate or High then the patient requires antibiotic prophylaxis for procedures that produce a significant bacteraemia. If the risk is deemed to the Low then no antibiotic is required for prophylaxis against Infective Endocarditis.
2. Procedures requiring prophylaxis If the cardiac risk is Moderate Risk or High Risk then the dentist should consider the details of the dental procedure. If any planned dento-gingival manipulative procedure causes a significant bacteraemia then it is clear that antibiotic prophylaxis is needed. The dental surgeon must undertake a careful appraisal of al dento-gingival manipulative procedures listed in Table 2 at the planning stage of the operation to ensure that all bacteraemia risk is ‘non-significant’ then antibiotic prophylaxis is not required even if the patient is moderate or high risk as regards the cardiac lesion.
The choice of antibiotic regime needs to be made by first identifying whether treatment is to be carried out under no or local anaesthesia. Table 3 provides the information required. If the treatment is to be carried out under general anaesthesia or intravenous sedation then the required information is in Table 4. For special concern patients, that is those with a prosthetic valve and/or previous endocarditis it is important to remember to use IV Amoxicillin and Gentamicin or IV Vancomycin and Gentamicin. This applies to patients treated under no anaesthesia or local anaesthesia as well as patients receiving treatment under Intravenous sedation or General Anaesthesia.
Further information can be obtained from web pages on the Royal College of Surgeons of England, (www.rcseng.ac.uk) or The Eastman Dental Institute and Hospital website (www.eastman.ucl.ac.uk).
It is important to write down the reason for giving the antibiotic prophylaxis and the choice of antibiotic. For a patient ‘at risk’ of developing endocarditis it is important that he/she understands the need to consult the doctor if any symptoms develop which may possibly be related to the onset of infective endocarditis. For example an unexplained fever or general malaise. Adherence to the recommendations whenever possible is recommended but it is recognized that there may be occasional circumstances where the clinician is required to adapt the recommendations to fit a particular clinical scenario. The reasons for the choices made must be recorded in the patient’s notes.
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New recommendations from the British Cardiac Society Guidelines and Medical Practices Committee and Royal College of Physicians Clinical Effectiveness and Evaluation Unite. 2004 |
