Antibiotic prophylaxis for patients undergoing dental care: a multi-centre evaluation in community and hospital dental services

Abstract

Background Infective endocarditis (IE) is a life-threatening condition known to be associated with transient bacteraemia, the source of which can be the oral cavity. Scottish Dental Clinical Effectiveness Programme (SDCEP) 2018 implementation advice was introduced to provide practical guidance on National Institute for Health and Care Excellence Clinical Guideline 64 (2016) for management of patients at risk of IE undergoing dental treatment. Aims To assess current compliance with SDCEP''s Antibiotic prophylaxis against infective endocarditis in six UK special care dentistry services. Method Four specific standards were set based on current guidance. Retrospective data were collected (from 01/01/2019 to 01/04/23) across six special care dentistry services in the UK, with an aim of 50 episodes of antibiotic prophylaxis (AP) in each service. Results In total, 248 episodes of care were included from dental services in London, East Surrey, Birmingham, Newcastle and North East England, Greater Glasgow and Clyde, and Newport (Wales). In 78% of episodes of care (n = 193), AP was administered to patients within SDCEP''s special consideration sub-group. Additionally, 91% of patients outside the SDCEP sub-group had a justified reason recorded for AP. In all but three cases (99%), patients had an invasive dental procedure following AP. In 92% of cases, antibiotics were administered as per SDCEP 2018 advice. Conclusion Even with national implementation advice, this evaluation demonstrates inconsistencies in provision of AP throughout the UK. Practitioners prescribing and administering AP should remain aware of the changing aetiology of IE, as well as the reasons for and against prophylaxis, so that patients can make an informed decision.