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Antibiotics before dental treatment could save lives


Up to 78 lives per year could be saved if dentists could administer antibiotics to vulnerable patients with heart conditions before dental treatment, research shows.

This comes as a group of professors discussed their concerns over the National Institute for Health and Care Excellence’s (NICE’s) guidelines position on the management of infective endocarditis (IE) in a recent paper.

According to the authors, nearly 400,000 people in the UK are at risk of developing IE following invasive dental treatment. Currently, up to 261 people are developing the disease each year, which can kill up to 30% of sufferers within a year, they said.

In addition, a recent study found that IE incidence in Europe has doubled over the past two decades.

As a result, the professors believe there is ‘considerable scope’ to permit dentists to administer antibiotic prophylaxis (AP) to vulnerable patients before dental treatment, which reduces the risk of developing IE.

This is in line with both the American Heart Association and the European Society of Cardiology – both of which’s guidelines endorse the need for AP to prevent IE in high risk cases.

For the last 16 years, however, NICE has not recommended routine AP use, which the authors claim is putting patients in danger. As such, they believe a review of NICE guidelines is essential so high risk patients in the UK ‘receive the same protection against IE that is afforded to patients in the rest of the world.’

In addition, their research shows that re-introducing AP into the UK is safe and cost-effective and would result in ‘significant cost savings and health benefits’.

High-risk individuals in the UK

Larry Baddour, one of the authors of the paper, said: ‘We have concerns that there are high-risk individuals in the UK who are at risk of infective endocarditis related to invasive dental procedures without antibiotic prophylaxis.

‘We believe a re-evaluation of [NICE’s] position is needed in high-risk individuals undergoing invasive dental procedures, who should receive antibiotic prophylaxis.’

A spokesperson for NICE told the Guardian: ‘NICE rejects the claim that patients are being harmed as a result of our guideline.

‘The guideline says that antibiotic prophylaxis against infective endocarditis is not routinely recommended for people undergoing dental procedures.

‘However, healthcare professionals should use their clinical judgment when implementing recommendations, taking into account the individual’s circumstances, needs and preferences.

‘Our surveillance team is due to review the current evidence relating to prophylaxis against infective endocarditis this year and will determine whether any new information, studies or research would support the case for a further update of existing Nice guidance.’

You can read the full paper here.


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