OK to Limit Pre-Dental Procedure Antibiotics to High Risk Heart Patients

Study Highlights:

  --  The incidence of infective may not have increased after the American
      Heart Association changed its recommendations on the use of antibiotics
      before invasive dental procedures.
  --  This study finding from Olmstead County, Minn., supports the guideline
      change, which limited the use of preventive antibiotics to people with
      the highest risks for complications from infective endocarditis.

DALLAS, June 11, 2012 (GLOBE NEWSWIRE) -- The incidence of infective
endocarditis among dental patients in Olmsted County, Minn. did not
increase after new guidelines called for giving preventive antibiotics
before dental procedures only to those at greatest risk of
complications, according to independent research published in
Circulation, an American Heart Association journal.

Infective endocarditis is a bacterial infection of the heart lining,
heart valve or blood vessel. Although rare, it can occur when bacteria
enter the bloodstream through breaks in the gums during invasive dental
procedures or oral surgery. It can cause death if untreated. A common
group of bacteria that cause this infection is viridans group
streptococci (VGS).

Patients with a heart weakened by certain congenital defects and
acquired conditions, including those with prosthetic heart valves, can
be more susceptible to the infection. People with normal heart valves
develop the infection less often.

In 2007, the American Heart Association changed its guidelines,
recommending patients take antibiotics before invasive dental
procedures only if they are at risk of complications from infective
endocarditis. This includes patients with artificial heart valves,
transplanted hearts with abnormal heart valve function, previous
infective endocarditis and people born with specific heart defects.

Before 2007, antibiotics were given to many more people, including
those with many types of congenital heart defect or acquired cardiac
condition. Antibiotics also were given for a wider range of procedures,
including operations involving the mouth, throat, gastrointestinal,
genital or urinary tract.

"We were giving preventive antibiotics like we were treating an entire
iceberg, when we only needed to treat the very tip of that iceberg,"
said Daniel C. DeSimone, M.D., study lead author and an internal
medicine resident at the Mayo Clinic in Rochester, Minn. "Millions of
people once getting antibiotics now are not."

In the first U.S. study examining VGS-related infective endocarditis
rates after the guidelines changed, investigators found a slight
decline in the number of patients diagnosed.

To compare infective endocarditis rates, researchers analyzed local
hospital discharge records in the Rochester Epidemiology Project and
national rates using the Nationwide Inpatient Sample. Olmstead County
was used because of its unique medical records-linkage system that
encompasses all residents of the county.

From Jan. 1, 1999 to Dec. 31, 2010, 22 patients in Olmsted County,
Minn., were diagnosed with the heart infection. These patients
represent two to three of every 100,000 people in the United States
before updated guidelines, and one of every 100,000 after the updated

The percentage of Olmsted county dentists following the new association
guidelines represented the percentage of dentists using them
nationally, researchers said.

The national annual infective endocarditis diagnosis rates showed no
increase, ranging from:

  --  15,300-17,400 in 1999-2006 (before the updated guideline)
  --  14,700-15,500 in 2007-09 (after the updated guideline)

"These findings are reassuring, but additional studies are needed to
further support our findings," DeSimone said.

"There's still a concern among many healthcare providers over whether
we are leaving certain people at risk of getting a potentially lethal
infection just from a dental cleaning or tooth extraction," he said.
"This study should reduce some fears. It will allow dentists to become
more comfortable when they tell a patient, 'You've been getting this
antibiotic for years. Now, it's not recommended anymore, and here is
data showing you why.'"

Among other limitation, the lack of diversity in Olmstead means these
results may not hold true for non-Caucasian populations.

Co-authors are Imad M. Tleyjeh, M.D., MSc.; Daniel D. Correa de Sa,
M.D.; Nandan S.

Anavekar, M.B., B.Ch.; Brian D. Lahr, M.S.; Muhammad R. Sohail, M.D.;
James M. Steckelberg, M.D.; Walter R. Wilson, M.D.; and Larry M.
Baddour, M.D. Author disclosures are on the manuscript.

The Baddour Family Fund Award, Mayo Foundation for Medical Education
and Research Funding supported the study.

Read the American Heart Association's 2007 guidelines.

The American Heart Association logo is available at


Statements and conclusions of study authors published in American Heart
Association scientific journals are solely those of the study authors
and do not necessarily reflect the association's policy or position.
The association makes no representation or guarantee as to their
accuracy or reliability. The association receives funding primarily
from individuals; foundations and corporations (including
pharmaceutical, device manufacturers and other companies) also make
donations and fund specific association programs and events. The
association has strict policies to prevent these relationships from
influencing the science content. Revenues from pharmaceutical and
device corporations are available at www.heart.org/corporatefunding.

NR12 -- 1084 (Circ/DeSimone)

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