[Antibiotic prophylaxis of infective endocarditis in stomatology--a survey of cardiologists].
According to epidemiological reports; 14-20% of infectious endocarditis (IE) are associated with previous stomatological procedures (oral surgery, procedures during periodontal and conservative endodontic therapy and intra-ligament anesthesia) which cause transitory bacteriemia for 10-15 minutes. In patients at risk, such short lasting bacteriemia is sufficient for the development of infectious endocarditis. In everyday practice we encounter patients at risk for IE referred to oral surgery (most often tooth extraction) at the Oral Surgery Division, Department of Facial, Maxillary and Oral Surgery, Dubrava University Hospital. Majority of these patients are given IE prophylaxis according to the latest AHA recommendations. For some patients we first consult a cardiologist due to the underlying disease, and as a rule these patients return with cardiologist's advice on IE prophylaxis. We noticed that these recommendations differ between cardiologists. Some cardiologists have for years been recommending the same "prophylaxis" which is not in accord with AHA guidelines. From the available cardiac records we analyzed antibiotic IE prophylaxis before oral surgery in cardiac patients at risk recommended by cardiologists in four Zagreb hospitals in 2003. We collected in total 17 recommendations prescribed by 12 cardiologists. Regretfully, none was in accord with valid AHA guidelines from 1997. Only 6 out of 17 recommendations are in agreement with the outdated guidelines from 1994, which also raises concern. Therefore, we thought it was worthwhile to present these cases, hoping this will stimulate discussion on common guidelines for the benefit of patients at risk for IE.
Macan
Darko
D
Klinika za kirurgiju lica, celjusti i usta, Klinicka bolnica "Dubrava", Stomatoloski fakultet, Zagreb.
Cabov
Tomislav
T
Snjarić
Damir
D
Perić
Berislav
B
Spicek
Jasna
J
Brajdić
Davor
D
D019072:Antibiotic Prophylaxis; D002309:Cardiology; D003625:Data Collection; D004697:Endocarditis, Bacterial / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D019647:Oral Surgical Procedures / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D012307:Risk Factors