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J Am Dent Assoc, Vol 138, No 4, 458-474. © 2007 American Dental Association

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JADA Continuing Education

Introduction. People with various medical conditions and devices are suggested candidates for receiving antibiotic prophylaxis before undergoing dental procedures. This practice is controversial, however, owing to the lack of proof of efficacy. The authors conducted a qualitative, systematic review to determine the level of evidence for this practice and whether antibiotic prophylaxis prevents distant site infections in these patients.

Methods. The authors selected eight groups of patients with specific medical conditions and devices who often are given antibiotic prophylaxis before undergoing invasive dental procedures. The conditions and devices were cardiac-native heart valve disease, prosthetic heart valves and pacemakers; hip, knee and shoulder prosthetic joints; renal dialysis shunts; cerebrospinal fluid shunts; vascular grafts; immunosuppression secondary to cancer and cancer chemotherapy; systemic lupus erythematosus; and insulin-dependent (type 1) diabetes mellitus. The authors thoroughly searched the literature for the years 1966 through 2005 for references indicating some level of support for this practice and graded each publication on the basis of level of evidence.

Results. The authors found formal recommendations in favor of antibiotic prophylaxis for only three of the eight medical conditions: native heart disease, prosthetic heart valves and prosthetic joints. They found no prospective randomized clinical trials and only one clinical study of antibiotic prophylaxis. Only one systematic review and two case series provided weak, if any, support for antibiotic prophylaxis in patients with cardiac conditions. The authors found little or no evidence to support this practice or to demonstrate that it prevents distant site infections for any of these eight groups of patients.

Conclusions. No definitive, scientific basis exists for the use of prophylactic antibiotics before dental procedures for these eight groups of patients.

Key Words: Antibiotic prophylaxis; bacteremia; amoxicillin; bloodborne pathogens; clinical protocols; dental care for chronically ill patients; endocarditis; bacterial endocarditis; heart murmur; heart valve diseases

Abbreviations: AAOS: American Association of Orthopaedic Surgeons • ACC: American College of Cardiology • ADA: American Dental Association • AHA: American Heart Association • AV: Arteriovenous • CSF: Cerebrospinal fluid • ID: Infectious diseases • IE: Infective endocarditis • GI: Gastrointestinal • PD: Peritoneal dialysis • SLE: Systemic lupus erythematosus • TEE: Transesophageal echocardiography • VC: Ventriculocardiac • VGS: Viridans group streptococci • VP: Ventriculoperitoneal

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