Antibiotic Prophylaxis for Dental Procedures PDF

Antibiotic prophylaxis Infective endocarditis (IE) Rare but serious (life threatening). Bacterial infection of hearts inner lining or valves. Predisposing cardiac conditions increase risk. 50% of new cases have no known pre-existing cardiac disease. Causes: Bacte...

Antibiotic prophylaxis Infective endocarditis (IE) Rare but serious (life threatening). Bacterial infection of hearts inner lining or valves. Predisposing cardiac conditions increase risk. 50% of new cases have no known pre-existing cardiac disease. Causes: Bacteria or fungi enter bloodstream and attach to the heart. Grow on the heart valves and cause inflammation. Oral streptococci implicated in some cases. Cumulative low grade bacteraemia are of more significance - (toothbrushing, flossing, chewing). Antibiotic prophylaxis Oral hygiene prevention Giving patients high dose antibiotics 1 hour before delivering advice is key! invasive dental treatment that might cause a bacteraemia. Prevents bacteria infecting the damaged endocardium. Usually Amoxycillin or Clindamycin. Bacteraemia = Risk of adverse reactions. Bacterial infection of the blood. NICE guidelines 2016+ ‘Antibiotic prophylaxis is not recommended routinely for people undergoing dental procedures’. Always record time taken in clinical notes! Standard antibiotic prophylaxis regime How to be taken Adults 18+: Amoxicillin, 3G, oral powder At Eastman, take antibiotic prophylaxis in sachet. hospital, 1 hour before dental treatment. Children: Amoxicillin oral suspension, 250mg/5ml. (Maximum dose 50mg/kg) In general practice, at first time, take If allergic to Amoxicillin: antibiotic prophylaxis in practice, 1 hour Adults: Clindamycin capsules, 300mg x2. before dental treatment. Children: Clindamycin, 20mg/kg. Subsequent times, patients can take at home, 1 hour before dental appointment. Increased risk Most risk Only the patients Require antibiotic prophylaxis. with conditions in bold need antibiotic Only for specific invasive dental prophylaxis. treatments. Only for specific invasive dental treatments. Invasive dental treatment = Likely to cause bleeding. Patients at increased risk: Patients most at risk: Explain that antibiotic prophylaxis Try to maximise Important patients are not discouraged is no longer routinely amount of from dental treatment. recommended. treatment in Liaise with referring GDP and Emphasise good oral health and each visit cardiologist about antibiotic prevention. prophylaxis. Discuss symptoms of endocarditis. Discuss benefits (prevention of IE) and Give information leaflet. risks (hypersensitivity, anaphylaxis). Ensure dental infections are treated Give information leaflet. promptly. Document discussions. Prevention ++++. Prescribing antibiotics Prescription is written by referring GDP. If patient has had a course of antibiotics in the last 6 weeks, select an antibiotic from a different class. HOWEVER, if patients require sequential invasive treatments over a short period of time, the same antibiotic can be prescribed for each treatment. If amoxicillin and Clindamycin are not suitable, seek advice. Invasive dental treatments: Matrix band placement. Sub-gingival rubber dam clamp placement. Sub-gingival restorations. Endodontic treatment. Preformed metal crowns. Full periodontal examination. Root surface instrumentation. Incision and drainage of abscess. Dental extractions. Surgery involving elevation of muco-periosteal flap or muco-gingival area. Placement of dental implants. Uncovering implant structures.