Prophylactic+Antibiotic+Premedication

= = **Prophylactic Antibiotic Premedication **  **Efficacy of antibiotic premedication for the prevention of infective endocarditis- Maria** The literature appears to be split when it comes to the efficacy of prophylactic premedication. This is because many studies have important differences with respect to the type and dose of antibiotic used. For instance, a recent study conducted by Vergis et al (2001) showed a reduction of 80% in the prevalence of post-extraction bacteremia after prophylaxis with 3g of amoxicillin. Diz Dios et al (2006) showed a 96% reduction with 2g of amoxicillin. In contrast, a study conducted by Hall et al (1993) and (1996) showed the prevalence of bacteremia was reduced by only 15% after administration of 2g of amoxicillin and only reduced by 26% after administration of 600mg of clindamycin respectively. Thus, because the literature does not conclusively support the efficacy or non-efficacy of prophylaxis premedication in the prevention of bacteremia, more studies need to be conducted. In the meantime, dental professionals should follow the prophylactic protocol of the American Heart Association. ** Need for Prophylactic Premedication - Dorinda Thomas ** Bacterial Endocarditis is rare condition but can be a fatal infection of the heart’s valves or inner lining that can lead to irreversible damage if a patient does get it.
 * Describe the evidence for prophylactic antibiotic premedication (pros and cons) including a review of the literature for the efficacy of prophylaxis antibiotic premedication. **

How do antibiotics prevent BE? Certain antibiotics can be taken taken as a premedication before a dental procedure, the antibiotics weaken any bacteria that may enter the blood. The weakened bacteria are then destroyed by the white blood cells before they can infect the heart. Recently the AHA updated their guidelines and the main reasons are: First they want to limit premedication to only those conditions truly needing it and second they want to limit the amount of antibiotic that needs to be taken. Also overtime antibiotics can be less effective if they are overused by a patient.

Endocarditis Prophylaxis is Recommended for the following: High Risk Category: Prosthetic cardiac valves, including bioprosthetic and homograft valves Previous bacterial endocarditis Complex cyanotic congenital heart disease Surgically constructed systemic pulmonary shunts or conduits Moderate Risk Category Most other congenital cardiac malformations Acquired valvular dysfunction (example: rheumatic heart disease) Hypertrophic cardiomyopathy Mitral valve prolapse with valvular regurgitation and/or thickened leaflets.

It is so important that we are aware of the different conditons that we need to premedicate for so we can work safely for our patients. Wilson, C. (1999, March). Dental Premedication. Retrieved February 21, 2009, from http://www.wilsondentist.com/premedic.htm ** Effective of antibiotic medication- Diem ** // The first guideline form AHA was called the European Consensus on bacterial endocarditis prophylaxis and was published in 1955 by the European Society and Cardiology and International Society of Chemotherapy. The last guideline was in 2007.

How effective antibiotic medications are used? Antibiotic is used to treat chronic periodontal disease to improve attachment level. Ampicillin, Ceftriaxone, and Cefazolin are used IM on patients who are unable to tolerate oral antibiotic. Amoxicillin is great antibiotic for tooth extraction procedure with 3g regimen. Clindamycin is used to treat recurrent periodontitis and target on gram negative anaerobic rods. One disadvantage of using Clindamycin is pseudomembranous colitis. Erythromycin is used for patients who has allergy to penicillin, but contraindication for pregant women because of fetal toxicity. Penicillin is the most unsafe antibiotic used due to fatal anaphylaxis. Tetracyclines is contraindicated for pregnant women due to tooth discoloration and hypoplasia. Because antibiotic is not 100% prevent the onset of endocarditis, AHA has narrowed the antibiotic to those with high risk of IE. References: Carmona, T., Dios, P. D., & Scully, C. (2007). Efficacy of antibiotic prophylactic regimens for the prevention of bacterial endocarditis of oral origin. The Journal of Dental Research, 86(12), 1142-1159. Retrieved February 17, 2009, from http://jdr.sagepub.com/cgi/reprint/86/12/1142. Wilson, W., Taubert, K. A., Gewitz, M., Lackhart, P. B., Baddour, L. M., (2009). Prevention of infective endocarditis: Guidelines from the American Heart Association. The Journal of the American Dental Association. Retrieved February 17, 2009, from http://jada.ada.org/cgi/reprint/138/6/739. // The way that is easy for me to remember which cardiac conditions warrant antibiotic pre-medication is CASH: **Cardiac transplant that develops valvular problems.** 1. Artificial heart valves. 2. Specific congenital heart defects ( unrepaired or incompletely repaired congenital heart defects). 3. History of infective endocarditis. Statistics: According to Cochrane database fo systematic review; out of 100,000 people 10 die due to IE every year, and a 30% of patients who take pre-meds die. Studies show that people at high risk of IE did not benefit prom pre-meds. The authors’ conclusion state "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". They also mention the emerging antibiotic resistance that bacteria develop against pre-medication; therefore, pre-medication should be prescribed with caution. Oliver, R., Roberts, G. J., Hooper, L., Worthington, H. V. (2009). Antibiotics for the prophylaxis of bacterial endocarditis in dentistry (review). Cochrane Database of Systematic Reviews, Issue 1, 2009.
 * Antibiotic Premedication - Jackie Rocamora **

According to JADA, 2000; there are only few situations in which pre-meds are indicated prior to performing dental treatment to prevent IE. Patients with compromised immune system represent a special category in dentistry due to the absence of an adequate host immune system, and may rapidly progress to a severe septicemia. In this category fall patients undergoing chemotherapy. These patients’ immune system is suppressed by their medications making them particularly susceptible to systemic infections. Patients with HIV and AIDS have an inability to fight against microbial infections because of a depressed immune system. Also, patients with poorly controlled and uncontrolled diabetes present a degree of leukocyte dysfunction which leads to a higher rate of IE; therefore, pre-medication is recommended.

Tong, D. C., & Rothwell, B. R. (2000). Antibiotic prophylaxis in dentistry: a review and practice recommendations. The Journal of the American Dental Association, 131, 366-374.

Need for prophylactic premedication for the prevention of endocarditis and remote site infections.**
 * Lia

Infective Endocarditis (IE) is an infection of the lining of the heart. Certain people may be at risk for acquiring this infection. Premedication before dental treatment with antibiotics has been indicated as a recommendation to prevent IE from occurring. According to Oliver, Roberts, Hooper & Worthington there is no supportive evidence as to whether antibiotic premedication is effective or not in preventing IE. Oliver, et al. states that it is not clear if the potential harm and risks associated with administering antibiotics outweighs the unproven benefits. The American Heart Association (AHA) has revised its guidelines to include only people at the highest risk for contracting IE. This revision was due to research that indicated that even if the antibiotic therapy was 100% effective there would only be a small number of instances to which it was proven effective against IE. (Wilson, Taubert, Gewitz, Lockhart, Baddour, Levison, Bolger, Cabell, Takahashi, Baltimore, Newburger, Strom, Tani, Gerber, Bonow, Pallasch, Shulman, Rowley, Burns, Ferrieri, Gardner, Goff & Durack, 2007).

Reference

Oliver, R., Roberts, G.J., Hooper, L., Worthington, H.V. (2008). Antibiotics for the prophylaxis of bacterial endocarditis in dentistry. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD003813. DOI: 10.1002/14651858.CD003813.pub3.

Carbell, C., Abrutyn, E., Karchmer, A.(2003). Bacterial endocarditis. Circulation107,e185-e187. Retrieved February 26, 2009 from http://circ.ahajournals.org/cgi/content/full/107/20/e185
 * Marcia**
 * Bacteremia ** occurs as part of our daily living when bacteria that normally live on the skin, the lining of the mouth, or the lining of the intestinal tract enter the bloodstream through small cuts, abrasions, or breakdowns. Patients who are at risk should be advised to maintain good oral hygiene to prevent more bacteriainto the bloodstream.

Brein

There have been recent updates in regards to which patients should be taking an antibiotic prior to a dantal visist to help prevent infective endocarditis. The major concern among health care professionals with antibiotic prophylaxis is the overuse of antibiotics, causing patients to become sensitive or allergic to antibiotics. These updated guidlines published in the Journal of the American Heart Association have be based on the growing evidence showing that most patients requiring a premed are facing more risk from taking the premed then the beneits provided by it. The new guidlines indicate that taking a premed antibiotic is not necessary for most patients. Using premed antibiotics can cause allergic reactions and aslo dangerous resistance to these antibiotics.

www.americanheart.org www.smiledesigncentre.com

// **PROPHYLACTIC REGIMENS FOR DENTAL, ORAL, RESPIRATORY TRACT, OR ESOPHAGEAL PROCEDURES**
 * //Reina://**

(Follow-up dose is no longer recommended.) Total children’s dose should not exceed adult dose.

Amoxicillin: Adults, 2.0 g (children, 50 mg/kg) given orally 1 hour before procedure. Ampicillin: Adults, 2.0 g (children, 50 mg/kg) given IM or IV within 30 minutes before procedure.
 * Standard**
 * If Unable to Take Oral Medications**


 * If Allergic to Amoxicillin/Ampicillin/Penicillin**

Clindamycin: Adults, 600 mg (children, 20 mg/kg) given orally 1 hour before procedure. Cephalexin* or Cefadroxil*: Adults, 2.0 g (children, 50 mg/kg) orally 1 hour before procedure. Azithromycin or Clarithromycin: Adults, 500 mg (children, 15 mg/kg) orally 1 hour before procedure.
 * OR:**
 * OR:**


 * Amoxicillin/Ampicillin/Penicillin Allergic Patients Unable to Take Oral Medications**

Clindamycin: Adults, 600 mg (children, 20 mg/kg) IV within 30 minutes before procedure. Cefazolin*: Adults, 1.0 g (children, 25 mg/kg) IM or IV within 30 minutes before procedure
 * OR:**


 * Cephalosporins should not be used in patients with immediate-type hypersensitivity reaction to penicillin.

Tomko, P. (2007). National dental hygienist licensure exam (2nd ed.). New York: Kaplan Medical Publishing.

SUMMARY RECOMMENDATIONS FOR ANTIBIOTIC PROPHYLAXIS //
 * **Medical Condition ** || **Prophylaxis Recommendation **  || **Antibiotic Regimen **  ||
 * Valvular heart disease, previous endocarditis, surgical pulmonary shunts, hypertrophic cardiomyopathy || Yes || American Heart Association (AHA) protocol ||
 * Mitral valve prolapse with regurgitation || Yes || <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">AHA protocol ||
 * <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">Prosthetic heart valves || <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">Yes || <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">AHA protocol ||
 * <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">Orthopedic prostheses more than 2 years in place || <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">No, except in exceptional cases of immune compromise ||

||
 * <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">Implanted pacemaker or defibrillator || <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">No ||

||
 * <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">Vascular grafts || <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">No, if in place more than 6 months || <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">AHA protocol if less than 6 months ||
 * <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">Previous coronary bypass graft surgery || <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">No ||

||
 * <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">Renal hemodialysis with arteriovenous shunts || <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">Yes, although definite evidence is lacking || <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">AHA protocol ||
 * <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">Ventriculoatrial shunts for hydrocephalus || <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">Yes || <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">AHA protocol ||
 * <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">Ventriculoperitoneal shunts for hydrocephalus || <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">No ||

|| Tong, D. C., & Rothwell, B. R. (2000, March). Antibiotic prophylaxis in dentistry: A review and practice recommendations. Journal of the American Dental Association, 131(3), 366-374. The American Academy of Orthopaedic Surgeons also issued some guidelines. The American Academy of Orthopaedic Surgeons also issued some updated guidelines. "An expert panel of dentists, orthopaedic surgeons, and infectious disease specialists, convened by the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS), performed a thorough review of all available data to determine the need for antibiotic prophylaxis to prevent hematogenous prosthetic joint infections in dental patients who have undergone total joint arthroplasties. The result is this report, which has been adopted by both organizations as an advisory statement. The panel's conclusion: Antibiotic prophylaxis is not indicated for dental patients with pins, plates, and screws, nor is it routinely indicated for most dental patients with total joint replacements. However, it is advisable to consider premedication in a small number of patients who may be at potential increased risk of hematogenous total joint infection." And, "Presently, no scientific evidence supports the position that antibiotic prophylaxis to prevent hematogenous infections is required prior to dental treatment in patients with total joint prostheses. The risk/benefit and cost/effectiveness ratios fail to justify the administration of routine antibiotic prophylaxis. The analogy of late prosthetic joint infections with infective endocarditis is invalid as the anatomy, blood supply, microorganisms, and mechanisms of infection are all different." AAOS recommends the dentist to consult patient's physician before proceeding dental procedures especially the ones that are within two years postsurgery, those who have had previous joint infections, and certain debilitated and immunocompromised patients. " "After this consultation, the dentist may decide to follow the physician's recommendation, or, if in the dentist's professional judgment, antibiotic prophylaxis is not indicated, may decide to proceed without antibiotic prophylaxis. The dentist is ultimately responsible for making treatment recommendations for his/her patients based on the dentist's professional judgment." If there is a conflict regarding antibiotic premedications, the AAOS recommends the dentist to use official document published by the AAOS to direct the physcian new guidelines toward the decision-making regarding premedication. The American Academy of Orthopaedic Surgeons.(2007) The new guidelines for antibiotic premedications. retrieved Febuary 24, 2009 from http://www.aaos.org/about/papers/advistmt/1014.asp. Noo
 * <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">Patients with compromised immune system || <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">No for most dental procedures; may consider for invasive procedures or specific situations || <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">No specific antibiotic regiment recommended ||
 * <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">Prevention of local infection in surgical sites || <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">No, although treatment of coexistent infection is recommended before surgical procedures || <span style="display: block; font-family: Times New Roman; text-align: left; msofareastfontfamily: 'Times New Roman';">No specific antibiotic regiment recommended ||

Infective endocarditis is rare but does have a 37%mortality and morbitity producing long-term effects for the patient (Press & Montessori, 2000). New guidelines have been issued by the AHA concluding that only patients that fall into the “high” risk category require antibiotic premedication (Nishimura, et al, 2008) which have been described above.

Patients that fall into the high risk category should receive antibiotic premedication for the scaling and root planning that we, as dental hygienists, provide so it is really important that we stay current on the scientific research involving antibiotic premedications. Nishimura et al. states that maintaining good oral hygiene is effective against bacteremias associated with infective endocarditis and is often more important than antibiotic premedication for a specific dental procedure. Once again, our role as educators is essential. We need to spend more time with oral hygiene instructions for patients that fall under the AHA “high” risk category to help them prevent infective endocarditis and also periodontal disease.

Nishimura, R., Carabello, B., Faxon, D., Freed, M, Lytle, B, et al. (2008) ACC/AHA 2008 Guideline Update on Valvular Heart Disease: Focused Update on Infective Endocarditis. Journal of American Heart Association.118 (8): 887-896.

Press N., & Montessori V. (2000) Prophylaxis for infective endocarditis. Who needs it? How effective is it? Canadian Family Physician. 46: 2248–2255.

Registered dental hygienists do not prescribe any pre-medication, but they defiantly need to know the current guidelines and research available. One very good question is if they patient has a long appointment should the RDH tell them to take an additional dose of antibiotics? From what we learned in medically compromised the antibiotic pre-med will not last much longer than 5-6 hours. We have learned they should take half of the original dose if the appointment will exceed six hours. According to Guerrero, a supplementary dose depends on the drugs pharmacokinetics (2008). He also states that the half-life of the antibiotic would help the physician determine if the patient needs an additional dose and how much it should be (Guerrero, 2008). The half life is extremely important and it is different for every drug. Amoxicillin’s half life is about 61 minutes. So after five hours there is around 3% left in the blood.

Another interesting piece of information was regarding cardiac pacemakers and internal defibrillators. The article stated that around 20% of people with a cardiac pacemaker develop an infection and it tends to occur soon after placement (Lockhart, Loven, Brennan, and Fox, 2007). A very important question for our pacemaker patients would be how long have they had there pacemaker. If it was recently placed they are obviously more at risk for an infection just by looking at the research. However, the AHA does recommend pre-med. The research says the bacteria that cause these infections are not present in high levels in the oral cavity.

Guerrero, J. S. (2008). Use of prophylactic antibiotic therapy in oral surgical procedures: A critical review. Journal of the California Dental Association, 36(12), 943-950.

Lockhart, P. B., Loven, B., Brennan, M. T., and Fox, P. C. (2007). The evidence base for the efficacy of antibiotic prophylaxis in dental practice. The Journal of the American Dental Association, 138(4), 458-474.

Antibiotic premedication has been practiced in dentistry for patients with heart conditions and those who are at risk for infective endocarditis (IE). We are familiar or will soon be very familiar with the recent updates made by the AHA on this practice. However, the question is - does the evidence show that it is more beneficial to premedicate patients with an antibiotic prior to dental treatment or is it more of a risk to the patient?
 * Antibiotic Prophylaxis - Stacy**

Research shows there is no evidence as to whether antibiotic premedication provides any value in preventing IE in patients at risk when undergoing dental treatment (Oliver, Roberts, Hooper & Worthington, 2008)

Questions dentists must ask: Are we overmedicating by recommending antibiotic premed for patients? Do the benefits outweigh the risk of possible allergic reaction to the medication? Does the evidence show that there is a decrease in IE cases following dental treatment because of the prophylaxis?

The focus should be on preventing IE by instilling excellent OH habits in these patients rather than prescribing antibiotics. Is this part of the correlation between perio disease and heart health? If patients had great OH care at home this would decrease the need for invasive dental procedures on these patients therefore decreasing their risk of IE.

Another aspect of dentistry, implants, is an area to think about when premedicating patients. Implant failure is partly due to bacterial contamination at the surgical site. So premedicating patients at risk for IE may be a necessary step to prevent failure of the implant (Esposito, Coulthard, Oliver, Thomsen & Worthington, 2008).

Reference: Oliver R, Roberts GJ, Hooper L, Worthington HV. (2008). Antibiotics for the prophylaxis of bacterial endocarditis in dentistry. Cochrane Database of Systematic Reviews 4(CD003813).

Esposito, M., Coulthard, P., Oliver, R., Thomsen, P. and Worthington, H.V. (2008). Antibiotics to prevent complications following dental imp

Other patients who need prophylatic premedication:

Patients who are taking bisphosphonate medication for the prevention of osteroporsis may take antibiotic or antimicrobial treatments are used to eliminate or reduce the possibility of infection.. Although there has been an increase in osteonecrosis of the jaw in people taking bisphosphonates, this is still only a very small percentage of people overall. Specific drugs are selected based upon the type of bacterial infection found. Patients on bisphoshonates are in high risk of getting osteonecrosis of the jaw this usually happens when dental treatment is provided while the patient is on their medications. Patients should get any dental treatment completed prior to getting on bisphosphonates. Oral hygiene needs to non- invasive the same oral hygiene instructions should be the same for patients undergoing cancer therapy because oral changes are very similar.

Reichel., L. C. (2006). Osteonecrosis of the jaw. Prostate- help. Retrieved February 26, 2008 from http://www.prostate-help.org/onj.html

Reichel., L. C. (2006). Osteonecrosis of the jaw. Prostate- help. Retrieved February 26, 2008 from http://www.prostate-help.org/onj.html

Ceri: Infective endocarditis is fatal with out antibiotic therapy. It has been argued that some of the people that are receiving antibiotics are damaging themselves more by constantly ingesting antibiotics than by preventing infective endocarditis. One study showed that there was more risk in having an anaphylactic (allergic) reaction to the penicillin than from actually dying from infective endocarditis.

As most have already mentioned in previous posts, the results have been inconclusive. And more research needs to be done, but I found something interesting in this article

“It would be useful to have evidence about the usefulness of antibiotic prophylaxis of endocarditis in dentistry from higher levels of evidence. As the incidence of endocarditis is so low, a randomized controlled trial, run over 2 years, would require approximately 60,000 patients with a cardiac risk factor for endocarditis to be included (a cohort study over 10 years would require approximately 18,000 patients). Such a trial would require an intense international effort.”

That being said, a study of that magnitude would also be difficult, because the cost of an antibiotic pre-medication is very inexpensive in comparison to leaving patients with that have a possibility of developing infective endocarditis untreated with the pre-medication. If the patient perhaps did obtain infective endocarditis, it is much more expensive to treat them. So, it appears that patients will still continued to be treated with the pre-medication even though results and effectiveness of using them is inconclusive.

Oliver, R., Roberts, G. J., Hooper, L., Worthington, H. V. (2008). Antibiotics for the prophylaxis of bacterial endocarditis in dentistry. //The Cochrane Collaboration. 8//(4), 1-24.

Another article that was published in 1998 before the American Heart Association had come out with the new guidelines for antibiotic predications and this article states the same information that has been written prior to this addition. How interesting that more than 10 years ago this information was being critiqued. The article stated that we needed scale back the amount of antibiotics being prescribed as a pre-medication. One person in the study stated “the less the evidence there is, the more antibiotic we give”. That should not be the philosophy, but I do understand the reasoning behind it. Because we do not know all that we should we are taking the safe route.

Durack, D., (1998). Antibiotics for Prevention of Endocarditis during Dentistry: Time To Scale Back? //Annals of Internal Medicine. 10//(129), 829-831. <span style="font-family: Times New Roman; mso-fareast-font-family: 'Times New Roman'; msofareastfontfamily: 'Times New Roman';">Antibiotic Premedication-Tawnya Due to the advances in research in 2007 the American Heart Association changed the guidelines as to which conditions require antibiotic pre medication before dental visits. Due to the risk of antibiotic resistance and the questions of effectiveness only patients at high risk of developing infective endocarditis should be pre medicated. Conditions include prosthetic heart valve, a history of infective endocarditis, certain forms of congenital heart disease, and valvulopathy after cardiac transplantation. A patient would need to pre medicate before a regular prophy, SRP, injections, radiographs, extractions, shedding of primary teeth and trauma to the lips. Proper communication between the dental professional and the patient must occur and be documented. If the dental professional does not confirm the patient has taken the medication and the patient develops IE, malpractice could be charged. The patient should take the pre medication one hour before services and no more than 1 time every two weeks to avoid resistance. The pro/cons of antibiotic pre medication are still being researched but the possibility of bacterial resistance could occur with the increased use of antibiotic. For this reason the risk of the resistance must be weighed against the possibility of a potentially deadly condition, infective endocarditis. As more research is conducted it is likely that these regulations will continue to change and it is so important for professionals in the medical and dental field to educate the patients on these changes. Kim, A. (2008). Infective endocarditis prophylaxis before dental procedures: New guidelines spark controversy. Cleveland Clinic Journal of Medicine. 75 (2) 89-92.

Antibiotic Premed-Jennifer As I researched the controversial topic of using antibiotic premed to prevent bacterima I found similar information as most of you. The main concern and draw back to the use of antibiotic premed before invasive dental treatment is the development of antibiotic resistant bacteria such as MERSA. The evidence supporting the new guidelines from AHA 2007 in what I see as a decrease in "high risk pt" is again similiar to what many of you have already said. I read in many articles that the previous reasoning for pre med lacks scientific foundation. The main statement I found is that bacterimia can be provoked through brushing, flossing and eating therefore exposure would be a normal incidence. I did read that those who floss on a daily basses did not get bacterima. Hense a clean mouth less bacteria to enter the blood stream. The reason the oral cavity seems to be such a high risk besides the fact that it is loaded with bacteria, is that one of the major bacteria found in bacterima was strep viridans, which is a spirokeete found in perio disease, but the staph found in bacterima is the bacteria that causes the most harm. A little Hygiene Humer: I think the best premed for these patient is scaling and root planning, then consistent re care and good oral hygiene.

Roda, R., Jimenez, Y., Carbonell, E., Carmen, C., Munoz, M., Carmen, G., etal.(2008, June). Bacteremia originating in the oral cavity: a review. med oral cir buccal,13(6).

Haghigi,D.(2008, April). Pre medication antibiotics and the dental visit. http://www.tdn.com/articles/2008/04/08/this_day/doc47fac8db45dcb825173722.txt

Dose,L. antibiotics for dental visits. http://www.deardoctor.com/in-this-issue/consultations/antibiotics-for-dental-visits/

Evidence behind Prophylaxis Premedication-Britney In 2007 the AHA (American Heart Association) changed the guidelines for antibiotic premedication for the prevention of infective endocarditis. The guidelines were changed due to studies that dealt with the need for pre med in certain conditions. There have also been many studies that deal with the pros and cons of premed when compared to the effects that it might have on the patient’s overall health and bacterial resistance to premed, overall the dilemma to pre med or not to premed is something that still needs to be researched and tested so that there can be a more definitive conclusion as to the benefits or disadvantages of premedicating patients.

As in many cases, when guidelines are changed there is a certain percentage of people who are either unaware of the changes or choose not to follow the new guidelines. When the AHA changed the guidelines for antibiotic pre medication there was a certain amount of dental professionals that didn’t completely comply with the guidelines. One of the main reasons for this lack of full compliance with the new guidelines was due to the personal beliefs of the dentist and what conditions or procedures require antibiotic premedication. Because of this I believe that it is important for all dental professionals to do their own research regarding the need for premed with different dental procedures and patient health conditions so that the patient can always benefit from the most recent information and research findings regarding the need for antibiotic premedication and the need for it.

References: Wilson, W., Taubert, K., Gewitz, M., Lockhart, P.B., Baddour, L.M., Levison, M., et al.. (2007, October). Prevention of Infective Endocarditis: Guidelines From the American Heart Association: A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation, 116: 1736 - 1754.

Zadic, Y., Findler, M., Livine, S.,Livine, L., & Elad, S., (2008). Dentists’ knowledge and implementation of the 2007 American Heart Association guidelines for prevention of infective endocarditis. Journal of Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics, 106, e16-e19.