From the Guidelines
Antibiotic prophylaxis is recommended for certain high-risk patients before dental procedures that involve manipulation of gingival tissue or the periapical region of teeth. The standard regimen for adults is amoxicillin 2 grams taken orally 30-60 minutes before the dental procedure, as outlined in the ACC/AHA 2008 guideline update on valvular heart disease 1. For patients allergic to penicillin, alternatives include clindamycin 600 mg, azithromycin 500 mg, or clarithromycin 500 mg, all taken orally 30-60 minutes before the procedure, as specified in the guideline update 1. Children should receive weight-adjusted doses: amoxicillin 50 mg/kg or appropriate alternatives.
Key Points
- Prophylaxis is specifically indicated for patients with:
- Prosthetic cardiac valves
- Previous infective endocarditis
- Certain congenital heart defects
- Cardiac transplants with valve regurgitation
- The rationale behind antibiotic prophylaxis is to prevent bacteremia from oral flora entering the bloodstream during dental procedures, which could lead to infective endocarditis in susceptible individuals, as noted in the guideline update 1.
- Most healthy patients without these specific cardiac conditions do not require antibiotic prophylaxis before dental procedures, as the risks of unnecessary antibiotic use (including allergic reactions and antibiotic resistance) outweigh the benefits, as emphasized in the guideline update 1.
Recommendations
- Antibiotic prophylaxis should be given only to a high-risk group of patients before dental procedures that involve manipulation of either gingival tissue or the periapical region of the teeth or perforation of oral mucosa, as recommended by the AHA Prevention of Infective Endocarditis Committee 1.
- Prophylaxis is no longer recommended for prevention of endocarditis for procedures that involve the respiratory tract unless the procedure is performed in a high-risk patient and involves incision of the respiratory tract mucosa, such as tonsillectomy and adenoidectomy, as stated in the guideline update 1.
- Prophylaxis is no longer recommended for prevention of infective endocarditis for GI or GU procedures, including diagnostic esophagogastroduodenoscopy or colonoscopy, as noted in the guideline update 1.
From the Research
Antibiotic Use Prior to Dental Procedures
- There is no direct evidence in the provided study to support the use of antibiotics prior to dental procedures 2.
- The study focuses on the co-infection of influenza type A and type B viruses, and does not mention the use of antibiotics in dental procedures 2.
- The study discusses the use of rapid diagnostic kits, RT-PCR, and virus isolation to confirm co-infection with influenza viruses, but does not provide information on antibiotic use 2.
- Therefore, there are no research papers in the provided evidence to assist in answering the question about antibiotic use prior to dental procedures.