新证据质疑NICE的内心炎预防指南
Martin Thornhill1, Bernard Prendergast2, Mark Dayer3
1Professor of Translational Research in Dentistry, Unit of Oral and Maxillofacial Medicine, Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK. m.thornhill@sheffield.ac.uk.
British dental journal
|May 10, 2024
概括
国家卫生和护理卓越研究所的指导方针以前建议不要在侵入性牙科手术 (IDP) 中使用抗生素预防,以预防传染性内心炎 (IE). 新证据表明,AP对高风险患者有效且具有成本效益,因此需要对指南进行审查.
科学领域:
- 心脏病学 心脏病学
- 传染性疾病 传染性疾病
- 公共卫生政策 公共卫生政策
背景情况:
- 自2008年以来,国家卫生和护理卓越研究所 (NICE) 的指导方针不建议在侵入性牙科手术 (IDP) 之前进行抗生素预防 (AP),以预防传染性内心炎 (IE).
- NICE的立场是基于对有效性缺乏的看法和对不良反应的担忧,认为AP不具有成本效益.
- 2015年NICE指南指出,AP"不是常规推的",造成了混乱,并偏离了国际指南,建议AP适用于高风险个人.
研究的目的:
- 审查有关抗生素预防 (AP) 预防侵袭性牙科手术 (IDP) 患者感染性内心炎 (IE) 的有效性和成本效益的现有证据.
- 为了突出NICE指南与对高风险患者的国际建议之间的差异.
- 根据新出现的科学数据,倡导对NICE指南进行审查.
主要方法:
- 审查最近的科学文献和数据.
- 对侵袭性牙科手术和传染性内心炎之间的关联进行分析.
- 在高风险人群中评估抗生素预防的风险-益处和成本效益.
主要成果:
- 新的数据证实了IDP和随后的IE之间存在显著的关联.
- 证据表明,AP在降低高风险患者的IE风险方面具有有效性.
- 高风险患者的IE风险超过了对AP的不良反应风险,从而确定了其成本效益.
结论:
- 目前的证据支持在接受侵袭性牙科手术 (IDP) 的高风险患者中使用抗生素预防 (AP),以预防传染性内心炎 (IE).
- 应该审查NICE指南,使其与国际标准保持一致,并保护高风险患者.
- 更新指南将确保英国患者获得与其他国家的 IE 相同的IE 保护.
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