There is debate in the dental community surrounding the issue of whether patients need antibiotic prophylaxis for dental procedures. Prescribers want to protect patients against infective endocarditis and joint infections, but there is also concern about the excessive use of antibiotics. Educating yourself on the current guidelines will help you determine the best course of action for your patients.
The official guidelines for antibiotic prophylaxis have changed over the years. Previously, it was recommended that all patients with joint replacements receive antibiotic prophylaxis. That is no longer the case. There are relatively few patient subgroups who actually need antibiotic premedication, according to the American Dental Association (ADA).
The ADA guidelines took effect in 2015, and since then antibiotic prophylaxis is no longer recommended to protect dental patients from joint infection. For patients with a history of complications associated with their joint replacement surgery, premedication should only be considered when treatment involves 'gingival manipulation or mucosal incision,' after a consultation with the patient and their orthopedic surgeon.
With respect to infective endocarditis, there is only a small group of patients with underlying cardiac conditions for whom premedication is recommended. As explained by the American Heart Association (AHA) and American College of Cardiology (ACC), this group includes individuals who have received prosthetic cardiac valves or components used to repair heart valves, previous infective endocarditis, unrepaired cyanotic congenital heart disease, certain patients with repaired congenital heart disease, and cardiac patients with valve regurgitation caused by a valve that is structurally abnormal. The AHA and ACC notes, however, that 'the evidence demonstrating the efficacy of antibiotic prophylaxis is lacking.'
Antibiotic premedication is given to patients to protect them, however it also carries risks. As noted by the Centers for Disease Control (CDC), when antibiotics are taken, protective bacteria are destroyed for several months. During this period, patients are vulnerable to infection by Clostridium difficile (C. difficile), a bacteria that causes colitis. Patients with this infection experience diarrhea, nausea, loss of appetite, fever and pain, and it can be life-threatening.
According to a CDC report released in 2015, C. difficile caused nearly 500,000 infections in the United States in 2014, and 29,000 patients died within a month of being diagnosed. Older adults who receive medical care and take antibiotics are most commonly affected. A further concern is the increase in drug-resistant bacteria, including C. difficile, as a result of the widespread use of antibiotics.
When patients are told that they no longer need premedication, they may be relieved — or they may be confused. If they are concerned about this change, explain that you are using the most current ADA and AHA recommendations. If your patient still insists that they need premedication, contact their physician or surgeon to seek their advice.
In case any of your coworkers are unaware of the current recommendations, keep a copy of the current guidelines in your office. You can also ask your colleagues to help make sure that your practice is sending a consistent message to all of your patients.
- According to current guidelines, few patients actually need premedication.
- The benefits of antibiotic prophylaxis before dental treatment also come with risks.
- C. difficile is a serious and potentially life-threatening infection that can occur as a result of antibiotic use.
It is crucial to stay up to date with the latest guidelines and recommendations to help you provide your patients with the best quality of care while protecting their health.