Impact of antibiotic prophylaxis on the incidence,nature, magnitude,and duration of bacteremia associated with dental procedures: A systematic review |
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| Affiliation: | 1. BioCruces Health Research Institute, Cruces University Hospital, University of the Basque Country (UPV/EHU), Bizkaia, Spain;2. Professor and Chair, Maxillofacial Surgery Department, BioCruces Health Research Institute, Cruces University Hospital, University of the Basque Country (UPV/EHU), Bizkaia, Spain; Consolidated research group (UPV/EHU IT821-13);3. Associate Professor, Stomatology I Department, University of the Basque Country (UPV/EHU), BioCruces Health Research Institute, Spain; Consolidated research group (UPV/EHU IT821-13);4. Chair Professor, Maxillofacial Surgery Department, BioCruces Health Research Institute, Cruces University Hospital, University of the Basque Country (UPV/EHU), Spain; Consolidated research group (UPV/EHU IT821-13);5. Associate Professor, Stomatology I Department, University of the Basque Country (UPV/EHU), BioCruces Health Research Institute, Spain; Consolidated research group (UPV/EHU IT821-13);1. Postgraduate Honours Student, College of Medicine and Dentistry, James Cook University, Cairns, Australia;2. Private Practice, Kilkenny, Republic of Ireland;3. Professor of Biostatistics and Public Health, The Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia;4. Professor of Biostatistics, University of South Australia Cancer Research Institute and School of Nursing and Midwifery, University of South Australia, Adelaide, Australia;5. Staff Specialist, Special Needs Dentistry, Westmead Hospital, Sydney West Local Health District;6. Honorary Clinical Lecturer Special Needs Dentistry, School of Dentistry, University of Sydney, Sydney, Australia;7. Associate Professor of Preventative and Special Needs Dentistry, College of Medicine and Dentistry, James Cook University, Cairns, Australia;8. Visiting Specialist in Special Needs Dentistry, Royal Darwin Hospital, Northern Territory Oral Health Services, Darwin, Australia |
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| Abstract: | BackgroundAntibiotic prophylaxis (AP) is used routinely in high-risk groups of patients to reduce bacteremia and the risk of developing infective endocarditis (IE). In this systematic review, the authors evaluated the efficacy of AP on the incidence, nature, magnitude, and duration of post-dental procedure bacteremia.MethodsThe authors conducted a systematic search of the literature using MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials up to and including May 2019. They included randomized clinical trials in which researchers compared antibiotics with a placebo or no treatment (as the control). They undertook random-effects meta-analyses to evaluate the incidence of bacteremia after dental procedures.ResultsThe authors included 12 studies in the review. The studies evaluated the incidence of bacteremia after AP with American Heart Association (AHA) protocol antibiotics (amoxicillin, clindamycin, cephalosporin, and azithromycin) or non-AHA protocol antibiotics (moxifloxacin and intravenous [IV] amoxicillin-clavulanic acid). The pooled analysis revealed that antibiotics significantly reduced the bacteremia incidence, but their effectiveness was moderate (risk ratio, 0.50; 95% confidence interval, 0.38 to 0.67). IV amoxicillin-clavulanic acid promoted a considerable reduction in bacteremia. However, in patients with penicillin allergies, antibiotics (that is, clindamycin and cephalosporin) had lower efficacy.Practical ImplicationsOral amoxicillin is still the antibiotic of choice to reduce bacteremia. IV amoxicillin-clavulanic acid could be used for patients at high risk of developing IE who require invasive dental procedures, have high levels of dental infection, and are to be treated under general anesthesia. In patients with penicillin allergies, oral azithromycin showed a higher efficacy for the reduction of bacteremia and the use of clindamycin should be reviewed. Antibiotic premedication should be limited to patients at high risk of developing IE, according to the indications of the AHA guide. |
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| Keywords: | Amoxicillin bacteremia prophylaxis antibiotics clindamycin infective endocarditis AHA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0045" }," $$" :[{" #name" :" text" ," _" :" American Heart Association AP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0055" }," $$" :[{" #name" :" text" ," _" :" Antibiotic prophylaxis AZT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0065" }," $$" :[{" #name" :" text" ," _" :" Azithromycin CC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0075" }," $$" :[{" #name" :" text" ," _" :" Clindamycin CFU" },{" #name" :" keyword" ," $" :{" id" :" kwrd0085" }," $$" :[{" #name" :" text" ," _" :" Colony-forming units CFX" },{" #name" :" keyword" ," $" :{" id" :" kwrd0095" }," $$" :[{" #name" :" text" ," _" :" Cephalosporin IE" },{" #name" :" keyword" ," $" :{" id" :" kwrd0115" }," $$" :[{" #name" :" text" ," _" :" Infective endocarditis IV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0125" }," $$" :[{" #name" :" text" ," _" :" Intravenous MXF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0135" }," $$" :[{" #name" :" text" ," _" :" Moxifloxacin NR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0155" }," $$" :[{" #name" :" text" ," _" :" Not reported RCT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0165" }," $$" :[{" #name" :" text" ," _" :" Randomized controlled clinical trials SR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0185" }," $$" :[{" #name" :" text" ," _" :" Systematic review |
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