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Study: patients don’t benefit from antibiotic prophylaxis

London—A paper in the British Medical Journal suggests that patients who are at risk from infective endocarditis don’t benefit from antibiotic prophylaxis before undergoing invasive dental procedures.

According to Dr. Peter Lockhart, the paper’s senior author, the purpose of the paper was to determine if there was a change in the incidence of endocarditis—an infection of the inner surface of the heart—following a March 2008 recommendation from the National Institute for Health and Clinical Excellence that physicians and dentists stop prescribing the antibiotic in the United Kingdom. In 2007, the American Heart Association changed its guidelines as a result of growing scientific evidence that for most people the risks of taking the antibiotic prescription is greater than any benefit, but the guidelines still suggest a small minority of cardiac patients may be at risk during certain dental procedures.

Dr. Lockhart noted that dental offices have been in the spotlight for more than 50 years because dental procedures can cause bacteria to enter the blood stream, but said there is no strong scientific data to show that dental procedures cause infective endocarditis.

The data was available to researchers because British hospitals operate under a universal system for compiling admission and discharge data, as well as diagnoses of patients. Researchers were able to access all cases of infective endocarditis in England during a 10-year period. By looking at data before and after the NICE recommendation, they discovered there was no change in the incidence of infective endocarditis in spite of an 82 percent drop in the prescription of antibiotic prophylaxis.

“Although our research strongly supports the NICE guidelines, there needs to be ongoing data monitoring to confirm our two years of follow up data,” Dr. Lockhart said. “A clinical trial of higher risk cardiac patients would be necessary for a definitive answer to this longstanding question regarding the benefit, if any, from antibiotic prophylaxis.”

The article was published online May 3. To see the full copy, visit www.bmj.com/content/342/bmj.d2392.full.