Antibiotic Prophylaxis Discussions With Patients

This guide outlines key points to address when discussing antibiotic prophylaxis (ABP) with patients at increased risk of infective endocarditis (IE). The goal is to ensure informed decision-making while promoting optimal oral and overall health.

Key Discussion Points

Risk of Infective Endocarditis

• Low Risk Overall: IE is a very rare but serious condition, with less than 1 case per 10,000 people annually in the general population.
• Increased Risk for Certain Patients: Patients with specific cardiac conditions have a slightly higher risk of IE following invasive dental procedures.
• Risk Context:
  • 1 in 10: Someone in your family.
  • 1 in 100: Someone in a street.
  • 1 in 1,000: Someone in a village.
  • 1 in 10,000: Someone in a small town.
  • 1 in 100,000: Someone in a large town.

Causes of Bacteraemia

• Dental Procedures: Invasive procedures like extractions may increase the chance of bacteria entering the bloodstream.
• Daily Activities: Routine activities such as brushing, flossing, and chewing also cause transient bacteraemia, emphasising the importance of maintaining good oral hygiene.

Prevention Advice

Antibiotic Prophylaxis

• Benefits and Risks:
  • ABP is no longer routinely recommended for dental procedures, as its effectiveness in preventing IE is unclear.
  • IE can still occur regardless of prophylaxis.
  • Side effects of antibiotics include nausea, diarrhoea, allergic reactions, and, in rare cases, anaphylaxis or antibiotic-associated colitis.
• Antibiotic Resistance: Discuss the global concern of antimicrobial resistance linked to indiscriminate antibiotic use.

Oral Health Maintenance

• Emphasise excellent oral hygiene to prevent oral diseases that could require invasive treatment and reduce oral bacteria entering the bloodstream.
• Highlight the importance of regular dental check-ups to address dental disease early.
• Advise reducing sugary snacks and drinks to prevent tooth decay.

Risks of Other Invasive Procedures

• Warn about the risks of invasive non-medical procedures, such as body piercing or tattooing, which may also increase the risk of IE.

Recognising Symptoms of Infective Endocarditis

Patients should contact their GP if they experience the following symptoms, particularly together or in a flu-like illness:

• Fever (≥38°C).
• Night sweats or chills.
• Breathlessness during physical activity.
• Weight loss.
• Fatigue.
• Muscle, joint, or back pain unrelated to recent physical activity.

Note: These symptoms are often due to less serious infections but should still be investigated. Patients should inform any healthcare provider about recent invasive dental treatments.

Non-Routine Management Discussions

For patients considering ABP as part of non-routine management:

• Explain potential benefits and risks, including hypersensitivity, anaphylaxis, and colitis.
• ABP should ideally be taken in the dental practice one hour prior to the procedure, with the patient remaining in the practice during the interval.
• If the patient prefers to take the antibiotic at home, advise them to confirm with the practice beforehand to ensure the procedure is still scheduled.
• Stress the importance of seeking urgent medical care if they experience severe diarrhoea (colitis).

Documentation

• Record all discussions with the patient in their clinical notes, including the risks, benefits, and decisions made.