Less antibiotic use in dentistry gave no increase in endocarditis

Date:
February 17, 2022
Source:
Karolinska Institutet
Summary:
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 shows.



FULL STORY ========================================================================== 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
the journal 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.

Supports the change in recommendation "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," says
the study's corresponding author Niko Va"ha"sarja, dentist and doctoral
student at the Department of Dental Medicine, Karolinska Institutet. "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." The registry
study encompassed 76,762 high-risk individuals and 396,048 individuals
at a low risk of infective endocarditis, who were monitored from 2008 to
2018 with the help of the Medical Birth Registry, the National Patient
Register and the Swedish Endocarditis Registry.

The recommendation was supplemented in 2016 with an instruction to
consider prophylactic antibiotic treatment if prescribed by the patient's doctor. It is unclear how this addition has influenced the prescription
of antibiotics by dentists.

Reduction of amoxicillin prescriptions After the change in recommendation
in 2012, prescriptions of amoxicillin in dentistry declined by
approximately 40 per cent. However, the study is unable to demonstrate
that this was an effect of the amended recommendation and amoxicillin
has other uses in dental medicine.

"The next step is to examine which dental procedures the individuals
in the risk group underwent during the 2008-2018 period, since this is information we lack and it could add to our knowledge of what is to date a poorly studied issue," says Mr Va"ha"sarja. "This and the study we've just published could inform similar recommendation changes in other countries, resulting in a reduction in antibiotic use." The study was financed by Karolinska Institutet, the Swedish Public Health Agency, Folktandvaarden Stockholm AB, the Steering Committee for Dental Research at Karolinska Institutet and Stockholm City and the Swedish Dental Association. There
are no reported conflicts of interest.

========================================================================== Story Source: Materials provided by Karolinska_Institutet. Note: Content
may be edited for style and length.


========================================================================== Journal Reference:
1. Niko Va"ha"sarja, Bodil Lund, Anders Ternhag, Bengt Go"trick, Lars
Olaison, Margareta Hultin, Anna Warnqvist, Carina Kru"ger Weiner,
Aron Naimi-Akbar. Infective endocarditis among high-risk individuals
- before and after the cessation of antibiotic prophylaxis in
dentistry: a national cohort study. Clinical Infectious Diseases,
2022; DOI: 10.1093/ cid/ciac095 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/02/220217141205.htm

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