Less antibiotic use in dentistry shows no increase in endocarditis

prophylactic antibiotics
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Sweden is one of the few countries that have removed the dental health recommendation to give prophylactic antibiotics to people at a higher risk of infection of the heart valves, so-called infective endocarditis. Since the recommendation was removed in 2012, there has been no increase in this disease, a registry study from Karolinska Institutet published in Clinical Infectious Diseases shows.

Infective endocarditis is a rare but life-threatening disease caused by bacterial infection of the heart valves that affects some 500 people a year in Sweden. Individuals with congenital heart disease, prosthetic heart valves or previous endocarditis are at higher risk of infection.

People at a higher risk of infective endocarditis in Sweden used to receive the antibiotic amoxicillin as a prophylactic ahead of certain dental procedures, such as tooth extraction, tartar scraping and surgery. This recommendation was lifted in 2012 due to a lack of evidence that the treatment was necessary and to help prevent antibiotic resistance by reducing antibiotic use.

A collaborative project involving researchers from Karolinska Institutet has now studied how the decision has affected the incidence of infective endocarditis.

“We can only see small, statistically non-significant variations in morbidity, nothing that indicates a rise in this infection in the risk group since 2012,” the study’s corresponding author Niko Vähäsarja said.

“Our study therefore supports the change in recommendation. This is an internationally debated issue and Sweden and the UK are the only countries in Europe to restrict antibiotic use like this.”

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  1. This is “drive-by” science and it’s tiresome. But I admit that there is little doubt that it’s hard to prove a negative in science, probably impossible. But this reportage seems to suggest it’s proven — when it’s not and when even if true, it’s almost impossible to prove it.

    Because this article mentions the U.K., it might be useful to mention what happened after the U.K. changed its rules. Oops, cases of IE went up. But this isn’t the whole story nor should it be. What really matters is some sort of fair cost-benefit analysis. And by 2016 that info was available in Britain and here’s the link… a link that supports AP in high risk IE patients. Which may be why the practice persists.


    I don’t know why the Swedes report differently, and I’m not willing to spend the hours needed to digest and dissect their report. But IMO the issue remains unsettled. And docs don’t treat populations, they treat individuals. And most docs and most individuals will come down in favor of AP, I know I would both for my patients who fit this mold and any family who does. But then, I’m the kinda doc who would rx. harmless ivermectin for early Covid infection — despite the cool-kid pressure not to do so. Esp. because they failed to make any argument within the cost-benefit matrix in which every clinical decision ought to be made.

    Disclaimer: I worked in this area with the ADA both when it came to IE and orthopedic implants. There remain no crystal clear answers and it’ll likely stay that way, sorry.


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