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Antibiotic prophylaxis for infective endocarditis: a systematic review and meta-analysis
Thomas J Cahill1, James L Harrison2, Paul Jewell1
1Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK.
Heart (British Cardiac Society)
|February 19, 2017
Summary
Antibiotic prophylaxis (AP) effectively reduces bacteria in the blood after dental procedures, but evidence for preventing infective endocarditis (IE) is limited. More high-quality studies are needed to clarify AP
Area of Science:
- Cardiology and Dental Medicine
- Infectious Diseases
- Evidence-Based Medicine
Background:
- Antibiotic prophylaxis (AP) use for preventing infective endocarditis (IE) is a subject of ongoing debate.
- Recent guidelines in Europe, USA, and UK have restricted or advised against AP for dental procedures.
- The efficacy of AP in preventing IE following dental interventions remains controversial.
Purpose of the Study:
- To systematically review and appraise the existing evidence on the use of AP for preventing bacteremia or IE in patients undergoing dental procedures.
- To evaluate the effectiveness of antibiotic prophylaxis in the context of current clinical guidelines and controversies.
Main Methods:
- Conducted comprehensive electronic searches across major databases (Medline, Embase, Cochrane Library, ISI Web of Science).
- Assessed study quality using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria and Cochrane Risk of Bias Tool.
- Two independent reviewers determined study eligibility, assessed methodology, and extracted data.
Main Results:
- Included 36 studies (10 time-trend, 5 observational, 21 trials) from 178 eligible studies.
- Trials showed AP reduces bacteremia (RR 0.53, 95% CI 0.49-0.57), but case-control studies question IE prevention efficacy in low-risk patients.
- One time-trend study suggests total AP restriction may correlate with increased IE incidence; data on relative restriction are conflicting.
Conclusions:
- The evidence base for AP in dental procedures is limited, heterogeneous, and often of poor methodological quality.
- Postprocedural bacteremia is an inadequate surrogate endpoint for IE.
- High-quality case-control studies are recommended to clarify the role of dental procedures in IE causation and AP efficacy.
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