Antibiotic prophylaxis in oral healthcare - the agreement between Swedish recommendations and evidence

• Published in: British dental journal Vol. 208; no. 3; p. E5
• Main Authors: Ellervall, E, Vinge, E, Rohlin, M, Knutsson, K
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 13.02.2010; Nature Publishing Group
• Subjects: 692/700; 692/700/565/1436/1983; Advisory Committees; Antibiotic Prophylaxis - standards; Antibiotics; Bacteremia - prevention & control; Basic Medicine; Dental Care for Chronically Ill - adverse effects; Dental Care for Chronically Ill - standards; Dentistry; Disease prevention; Drug Industry; Evidence-Based Dentistry; Farmakologi och toxikologi; Humans; Immune system; Läkemedelskemi; Medical and Health Sciences; Medicin och hälsovetenskap; Medicinal Chemistry; Medicine; Medicinska och farmaceutiska grundvetenskaper; Odontology; Patients; Pharmaceuticals; Pharmacology and Toxicology; Practice Guidelines as Topic; Prostheses; Sweden; Systematic review; Transplants & implants; Sweden
• ISSN: 0007-0610; 1476-5373; 1476-5373
• DOI: 10.1038/sj.bdj.2010.107

Key Points According to evidence, there are few medical conditions for which antibiotic prophylaxis should be used. Recommendations in Sweden include many different medical conditions for which antibiotic prophylaxis should be used. To avoid the risk of adverse events and of developing resistant bacterial strains, recommendations in Sweden should be more evidence-based. Background Almost all (17/20) Swedish counties have pharmaceutical committees that establish recommendations for the use of antibiotic prophylaxis in oral healthcare. Objective To evaluate the evidence for the use of antibiotic prophylaxis in oral healthcare and the agreement between Swedish recommendations and evidence. Material and methods We conducted a systematic literature search in PubMed and the Cochrane Controlled Trials Register. The MeSH terms 'antibiotic prophylaxis' and 'dentistry' were used in the database search. Abstracts were reviewed according to specific inclusion and exclusion criteria. A total of 186 articles were read in full text by the four authors independently. Data extraction and interpretation of data was carried out using a pre-defined protocol. In the end, one case-control study was included for evaluation of evidence. Results The case-control study included patients with specific cardiac conditions. The study reported a 49% protective efficacy (odds ratio: 0.51) of antibiotic prophylaxis for first-time episodes of endocarditis within 30 days of procedure. This result was not statistically significant. The quality of the evidence was low. No studies were evaluated on patients with other medical conditions. The recommendations included several cardiac and other medical conditions for which there is a lack of evidence or no evidence to support the use of antibiotic prophylaxis. Conclusions There is a lack of evidence to support the use of antibiotic prophylaxis. To avoid the risk of adverse events from antibiotics and the risk of developing resistant bacterial strains, the use of antibiotic prophylaxis should be minimised and recommendations in Sweden should be revised to be more evidence-based.