Infective endocarditis is a severe infection arising in the lining of the heart with a high mortality rate.
Many dental procedures cause bacteraemia and it was believed that this may lead to bacterial endocarditis (BE) in a few people. Guidelines in many countries have recommended that prior to invasive dental procedures antibiotics are administered to people at high risk of endocarditis. However, recent guidance by the National Institute for Health and Clinical Excellence (NICE) in England and Wales has recommended that antibiotics are not required.
To determine whether prophylactic antibiotic administration compared to no such administration or placebo before invasive dental procedures in people at increased risk of BE influences mortality, serious illness or endocarditis incidence.
The search strategy from the previous review was expanded and run on MEDLINE (1950 to June 2008) and adapted for use on the Cochrane Oral Health, Heart and Infectious Diseases Groups' Trials Registers, as well as the following databases: CENTRAL (The Cochrane Library 2008, Issue 2); EMBASE (1980 to June 2008); and the metaRegister of Controlled Trials (to June 2008).
Due to the low incidence of BE it was anticipated that few if any trials would be located. For this reason, cohort and case-control studies were included where suitably matched control or comparison groups had been studied. The intervention was the administration of antibiotic compared to no such administration before a dental procedure in people with an increased risk of BE. Cohort studies would need to follow those at increased risk and assess outcomes following any invasive dental procedures, grouping by whether prophylaxis was received. Included case-control studies would need to match people who had developed endocarditis (and who were known to be at increased risk before undergoing an invasive dental procedure preceding the onset of endocarditis) with those at similar risk but who had not developed endocarditis. Outcomes of interest were: mortality or serious adverse event requiring hospital admission; development of endocarditis following any dental procedure in a defined time period; development of endocarditis due to other non-dental causes; any recorded adverse events to the antibiotics; and cost implications of the antibiotic provision for the care of those patients who develop endocarditis.
Data collection and analysis
Two review authors independently selected studies for inclusion, then assessed quality and extracted data from the included study.
No randomised controlled trials (RCTs), controlled clinical trials (CCTs) or cohort studies were included. One case-control study met the inclusion criteria. It collected all the cases of endocarditis in The Netherlands over 2 years, finding a total of 24 people who developed endocarditis within 180 days of an invasive dental procedure, definitely requiring prophylaxis according to current guidelines and who were at increased risk of endocarditis due to a pre-existing cardiac problem. This study included participants who died because of the endocarditis (using proxys). Controls attended local cardiology outpatient clinics for similar cardiac problems, had undergone an invasive dental procedure within the past 180 days and were matched by age with the cases. No significant effect of penicillin prophylaxis on the incidence of endocarditis could be seen. No data were found on other outcomes.
There remains no evidence about whether penicillin prophylaxis is effective or ineffective against bacterial endocarditis in people at risk who are about to undergo an invasive dental procedure. There is a lack of evidence to support previously published guidelines in this area. It is not clear whether the potential harms and costs of antibiotic administration outweigh any beneficial effect. Ethically practitioners need to discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about administration.
感染性心內膜炎是發生在心臟內襯細胞,高死亡率的嚴重感染情況.許多牙科處理程序會造成菌血症,且被認為可能在某些病人會造成細菌性心內膜炎.許多國家建議在一些危險群的病人接受較具侵犯性的牙科治療前使用抗生素預防.然而最近在英格蘭和威爾士的國家健康及臨床卓越學會(the National Institute for Health and Clinical Excellence;NICE)提出的方針中卻建議不需術前使用抗生素.
從MEDLINE搜尋之前從1950年∼2008年六月的評論文章,並改寫應用在the Cochrane Oral Health, Heart and Infectious Diseases Groups' Trials Registers, 以及以下的資料庫: CENTRAL (The Cochrane Library 2008, Issue 2); EMBASE (1980 to June 2008); and the metaRegister of Controlled Trials (to June 2008).
病例對照研究包含非隨機控制的試驗(randomised controlled trials; RCTs),控制的臨床試驗(controlled clinical trials; CCTs)或世代研究(cohort studies)這些準則.兩年多的時間搜集了所有在荷蘭心的內膜炎病例,發現總共有24個病人在侵犯性牙科治療後180天內發生心內膜炎,根據目前的治療方針和之前已有心臟疾病的高風險病人,術前的預防性抗生素是肯定必要的.這個實驗中包含因心內膜炎死亡的病例.對照組中在牙科治療後180天內發生相似心臟疾病的患者至心臟科門診求診,依照年齡和病例配對.結果顯示術前給予penicillin預防對於心內膜炎的發生率沒有明顯的效果.沒有資料顯示其他結果.
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。