Antibiotic prophylaxis for dental procedures: is it necessary?

Guidelines regarding the prevention of infective endocarditis have recently been published by the British Society for Antimicrobial Chemotherapy in 2006, the American Heart Association (AHA) in 2007 and the National Institute for Health and Clinical Excellence (NICE), UK, in 2008. These are contradictory, even though all are from developed countries. It is not known whether they are suitable for developing countries such as South Africa, nor is it known whether they are followed by general dental practitioners.

To conduct a survey amongst dental practitioners in South Africa to determine knowledge of the more recent AHA and NICE guidelines and the practices followed in antibiotic prophylaxis.

E-mails were sent to dentists registered with SADA requesting their participation in an internet-based survey.

The limited response rate necessitated the pooling of the data, but it was felt they would be valuable if some trends emerged. Most (88%) of the 105 respondents were aware of the AHA guidelines, but only 55% knew of the NICE guidelines. However, few actually followed the recommendations and few correctly prescribed for patients allergic to penicillin. The large number of cases of rheumatic fever in this country implies that the AHA and NICE guidelines may not be appropriate.

Despite the low sample size, the trends shown are of real concern. There is clearly a need for local guidelines, and once these are established, there is an urgent need to inform all dental practitioners of the appropriate prescription of prophylaxis for patients.