Prophylactic Antibiotics to Prevent Infective Endocarditis in High Risk Cardiac
Patients during Invasive Dental Procedures
Problem/Significance
Antibiotics have long been prescribed
prophylactically for dental procedures to
reduce the risk of infective endocarditis,
but now they are of growing concern.
Prescribing antibiotics when
unnecessary can lead to antibiotic
resistance, super infections, and allergic
reactions. Prescribers need to be very
cautious when it comes to antibiotics
and carefully review all the risks and
benefits for the patient.
Purpose
The purpose of this literature review is to
examine outcomes, specifically infective
endocarditis, in high-risk cardiac patients
that received antibiotics prior to an invasive
dental procedure.
PICOT Question
In high-risk cardiac patients, how does
prescribing antibiotics prior to an invasive
dental procedure compared to not
prescribing antibiotics affect the prevention
of infective endocarditis within 180 days?
Bitonte College of Health and Human Services
Nikki Tacsik, BSN, RN YSU MSN FNP Student
Method of Review/Results
Five databases were used to search for
literature. They were:
-ProQuest
-Google Scholar
-PubMed
-MEDLINE EBSCOhost
-TRIP
The search terms that were used were:
-antibiotic prophylaxis
-dental
-infective endocarditis
Ten articles were ultimately chosen from
the above search. Three articles were from
PubMed, one article was from MEDLINE
EBSCOhost, three were from Google
Scholar, two were from ProQuest, and one
was from TRIP.
Summary of The State of the
Science
After reviewing the literature, the majority
of studies that have been done support the
current guidelines for prescribing
antibiotics. Antibiotics used
prophylactically for dental procedures
appear to be unnecessary and have more
risks than benefits in most cases.
More studies need to be done that
observe high risk cardiac patients.
EBP Recommendations
- The American Heart Association
guidelines were changed since there is no
evidence to prove prophylactic antibiotics
are beneficial.
- Overall, antibiotics are overprescribed and
should not be given to most patients
undergoing dental procedures.
- Literature does seem to support the use of
antibiotics for high-risk cardiac patients.
Recommendations for Future
Research
-Since the American Heart Association
published the new guidelines, I recommend
additional studies are needed to evaluate the
new intervention.
-More studies need to be done comparing high
risk cardiac patients receiving or not receiving
antibiotics prior to an invasive dental procedure
and the rate of infective endocarditis post
procedure.
References available upon request.
Department of Nursing