TY - JOUR
T1 - Prescribing of antibiotic prophylaxis to prevent infective endocarditis
AU - Thornhill, Martin H.
AU - Gibson, Teresa B.
AU - Durkin, Michael J.
AU - Dayer, Mark J.
AU - Lockhart, Peter B.
AU - O'Gara, Patrick T.
AU - Baddour, Larry M.
N1 - Funding Information:
This study was funded by a research grant from Delta Dental of Michigan and its Research and Data Institute. The funding source had no role in the study design, collection, analysis or interpretation of the data, in the writing of the report, or in the decision to submit the article for publication.
Funding Information:
Disclosures. Drs. Thornhill, Gibson, Lockhart, and O’Gara received support from the Delta Dental Research and Data Institute for the submitted work. Dr. O'Gara received support from Medtronic, Edwards Scientific, and the National Heart Lung Blood Institute, National Institutes of Health, which was unconnected to the submitted work. Dr. Dayer received reports from Biotronik, which was unconnected to the submitted work. None of the other authors reported financial relationships with companies that might have an interest in the submitted work. Drs. Thornhill, Gibson, Durkin, and O’Gara have no nonfinancial interests that might be relevant to the submitted work. Dr. Lockhart is a member of the Writing Committee for the next American Heart Association’s guidelines on antibiotic prophylaxis to prevent infective endocarditis. Drs. Baddour and Lockhart were members of the American Heart Association’s Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease and were involved in producing the 2007 American Heart Association guideline on prevention of infective endocarditis. Dr. Dayer was a consultant to the review committee that produced the 2015 update to National Institute for Health and Care Excellence (UK) clinical guideline 64 on prophylaxis against infective endocarditis.
Funding Information:
Disclosures. Drs. Thornhill, Gibson, Lockhart, and O'Gara received support from the Delta Dental Research and Data Institute for the submitted work. Dr. O'Gara received support from Medtronic, Edwards Scientific, and the National Heart Lung Blood Institute, National Institutes of Health, which was unconnected to the submitted work. Dr. Dayer received reports from Biotronik, which was unconnected to the submitted work. None of the other authors reported financial relationships with companies that might have an interest in the submitted work. Drs. Thornhill, Gibson, Durkin, and O'Gara have no nonfinancial interests that might be relevant to the submitted work. Dr. Lockhart is a member of the Writing Committee for the next American Heart Association's guidelines on antibiotic prophylaxis to prevent infective endocarditis. Drs. Baddour and Lockhart were members of the American Heart Association's Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease and were involved in producing the 2007 American Heart Association guideline on prevention of infective endocarditis. Dr. Dayer was a consultant to the review committee that produced the 2015 update to National Institute for Health and Care Excellence (UK) clinical guideline 64 on prophylaxis against infective endocarditis. This study was funded by a research grant from Delta Dental of Michigan and its Research and Data Institute. The funding source had no role in the study design, collection, analysis or interpretation of the data, in the writing of the report, or in the decision to submit the article for publication.
Publisher Copyright:
© 2020 American Dental Association
PY - 2020/11
Y1 - 2020/11
N2 - Background: In 2007, the American Heart Association recommended that antibiotic prophylaxis (AP) be restricted to those at high risk of developing complications due to infective endocarditis (IE) undergoing invasive dental procedures. The authors aimed to estimate the appropriateness of AP prescribing according to type of dental procedure performed in patients at high risk, moderate risk, or low or unknown risk of developing IE complications. Methods: Eighty patients at high risk, 40 patients at moderate risk, and 40 patients at low or unknown risk of developing IE complications were randomly selected from patients with linked dental care, health care, and prescription benefits data in the IBM MarketScan Databases, one of the largest US health care convenience data samples. Two clinicians independently analyzed prescription and dental procedure data to determine whether AP prescribing was likely, possible, or unlikely for each dental visit. Results: In patients at high risk of developing IE complications, 64% were unlikely to have received AP for invasive dental procedures, and in 32 of 80 high-risk patients (40%) there was no evidence of AP for any dental visit. When AP was prescribed, several different strategies were used to provide coverage for multiple dental visits, including multiday courses, multidose prescriptions, and refills, which sometimes led to an oversupply of antibiotics. Conclusions: AP prescribing practices were inconsistent, did not always meet the highest antibiotic stewardship standards, and made retrospective evaluation difficult. For those at high risk of developing IE complications, there appears to be a concerning level of underprescribing of AP for invasive dental procedures. Practical Implications: Some dentists might be failing to fully comply with American Heart Association recommendations to provide AP cover for all invasive dental procedures in those at high risk of developing IE complications.
AB - Background: In 2007, the American Heart Association recommended that antibiotic prophylaxis (AP) be restricted to those at high risk of developing complications due to infective endocarditis (IE) undergoing invasive dental procedures. The authors aimed to estimate the appropriateness of AP prescribing according to type of dental procedure performed in patients at high risk, moderate risk, or low or unknown risk of developing IE complications. Methods: Eighty patients at high risk, 40 patients at moderate risk, and 40 patients at low or unknown risk of developing IE complications were randomly selected from patients with linked dental care, health care, and prescription benefits data in the IBM MarketScan Databases, one of the largest US health care convenience data samples. Two clinicians independently analyzed prescription and dental procedure data to determine whether AP prescribing was likely, possible, or unlikely for each dental visit. Results: In patients at high risk of developing IE complications, 64% were unlikely to have received AP for invasive dental procedures, and in 32 of 80 high-risk patients (40%) there was no evidence of AP for any dental visit. When AP was prescribed, several different strategies were used to provide coverage for multiple dental visits, including multiday courses, multidose prescriptions, and refills, which sometimes led to an oversupply of antibiotics. Conclusions: AP prescribing practices were inconsistent, did not always meet the highest antibiotic stewardship standards, and made retrospective evaluation difficult. For those at high risk of developing IE complications, there appears to be a concerning level of underprescribing of AP for invasive dental procedures. Practical Implications: Some dentists might be failing to fully comply with American Heart Association recommendations to provide AP cover for all invasive dental procedures in those at high risk of developing IE complications.
KW - Infective endocarditis
KW - antibiotic prophylaxis
KW - antibiotic stewardship
KW - dental procedures
KW - guidelines
KW - prevention
KW - risk
UR - http://www.scopus.com/inward/record.url?scp=85092531839&partnerID=8YFLogxK
U2 - 10.1016/j.adaj.2020.07.021
DO - 10.1016/j.adaj.2020.07.021
M3 - Article
C2 - 33121605
AN - SCOPUS:85092531839
SN - 0002-8177
VL - 151
SP - 835-845.e31
JO - Journal of the American Dental Association
JF - Journal of the American Dental Association
IS - 11
ER -