From the Guidelines
Antibiotic prophylaxis before dental procedures is recommended only for specific high-risk patients to prevent infective endocarditis, as stated in the 2015 ESC guidelines 1.
Patient Selection
Patients who should receive prophylaxis include those with:
- Prosthetic heart valves
- Previous infective endocarditis
- Certain congenital heart defects
- Cardiac transplant recipients with valve regurgitation These guidelines are based on the latest recommendations from the European Society of Cardiology (ESC) 1 and are consistent with previous guidelines from the American Heart Association (AHA) 1.
Prophylaxis Regimen
The standard regimen for adults is amoxicillin 2g orally taken 30-60 minutes before the procedure. For patients allergic to penicillin, alternatives include:
- Clindamycin 600mg
- Azithromycin 500mg
- Clarithromycin 500mg orally Children receive weight-adjusted doses:
- Amoxicillin 50mg/kg
- Clindamycin 20mg/kg These regimens are recommended to prevent bacteria from entering the bloodstream during dental work and potentially causing infection in vulnerable cardiac tissues.
Procedure Selection
Prophylaxis is specifically indicated for procedures involving:
- Manipulation of gingival tissue
- The periapical region of teeth
- Perforation of oral mucosa Most patients with heart conditions not listed above, including those with mitral valve prolapse or coronary artery disease, no longer require prophylaxis as the risks of antibiotic use (including allergic reactions and antibiotic resistance) outweigh the benefits for these lower-risk groups, as noted in the AHA guidelines 1.
From the Research
Dental Prophylaxis Antibiotic
- The use of antibiotic prophylaxis in dentistry is a topic of debate, with some guidelines recommending its use to prevent infective endocarditis (IE) in high-risk patients 2, 3.
- However, other guidelines suggest that antibiotic prophylaxis is not necessary for most patients undergoing dental procedures 4, 5, 6.
- The American Heart Association recommends antibiotic prophylaxis for patients at high risk of IE before undergoing invasive dental procedures 3.
- A study found that antibiotic prophylaxis was associated with a significant reduction in IE incidence following invasive dental procedures in high-risk patients 3.
- Another study found no significant effect of penicillin prophylaxis on the incidence of endocarditis 4, 5, 6.
- The level of certainty about the evidence is very low, and it is not clear whether the potential harms and costs of antibiotic administration outweigh any beneficial effect 4, 5, 6.
- Practitioners should discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about administration 2, 4, 5, 6.
- The use of antibiotic prophylaxis should be based on a risk-benefit evaluation, taking into account the individual patient's risk factors and medical history 2.