Cochrane · intervention · CD003813
Antibiotic prophylaxis for preventing bacterial endocarditis following dental procedures
Rutherford, SJ, Glenny, A-M, Roberts, G, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
5
current version
GRADE rated
1
No studies
4
Included studies
1
as reported
No studies 4 · 80%Ungraded 0 · 0%Very low 1 · 20%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults or children with any of the following pre-existing cardiac defects (i.e. known to be at risk): congenital heart defects, a history of rheumatic fever, prosthetic heart valves (tissue and mechanical), or who had had endocarditis previously; people with pacemakers and no other risk factors were excluded. Dental procedures included: supragingival and subgingival scaling of teeth, extensive restorations, endodontics, and oral surgery including dental extractions, under local or general anaesthetic. | One case-control study (Van der Meer 1992): 48 people with definite native-valve endocarditis and a pre-existing cardiac condition who had had an invasive dental procedure with an indication for prophylaxis within 180 days (case group; 44 with a definite (24) or possible (20) indication), matched to 200 controls at similar cardiac risk (181 with a definite or possible indication) (n=1 study). |
| Intervention | Administration of an antibiotic, compared with no such administration or placebo, before a dental procedure (oral, intravenous or intramuscular routes, but not topical). Studies with post-operative administration were included if part of a pre-operative protocol. Co-interventions may have included pre-operative mouthwash or mechanical cleaning of teeth. | Antibiotic prophylaxis (n=7) |
| Comparison | No such administration or placebo | No prophylaxis (n=17) |
| Outcomes | Primary outcomes: (1) Mortality or serious adverse events (from any cause) requiring hospital admission; (2) Development of endocarditis following any dental procedure in a defined time period; (3) Development of endocarditis due to other non-dental causes. Secondary outcomes: (1) Any recorded adverse events to the antibiotics; (2) Cost implications of antibiotic provision for prophylaxis compared with the cost of care of those who develop endocarditis. | Development of endocarditis following dental procedure (n=24); Mortality or serious adverse events requiring hospital admission (n=0); Any recorded adverse events to antibiotics (n=0); Cost implications (n=0) |
| Study designs | Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) where available; cohort and case-control studies where suitably matched control or comparison groups had been studied. | Case-control study (n=1) |
| Timing | No minimum time period for cohort studies; defined time period for endocarditis development following dental procedures (e.g. within 180 days). | Median time between a dental procedure requiring definite prophylaxis and onset of endocarditis was 10 days in cases; median time between the procedure and interview was 71 days in controls; exposure window 180 days. |
Search date: May 2021. Databases: Cochrane Oral Health's Trials Register; CENTRAL; MEDLINE Ovid; Embase Ovid; World Health Organization International Clinical Trials Registry Platform
Questions and results
Current version onlyAntibiotic prophylaxis before dental procedure vs No antibiotic prophylaxis or placebo
Population: Adults or children at increased risk of bacterial endocarditis (pre-existing cardiac condition) undergoing an invasive dental procedure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality or serious adverse events requiring hospitalisation | Mortality or serious adverse events requiring hospitalisation | No data reported | 248 (1 study) | - | - | 0 studies | No studies |
Development of endocarditis due to other (non-dental) causes | Only four cases developed endocarditis following non-dental medical interventions (within the past 180 days and with pre-existing cardiac indications for the use of prophylaxis), so assessment of the effects of… | 0 studies | No studies |
Adverse effects of antibiotics | Adverse effects of antibiotics | No data reported | 248 (1 study) | - | - | 0 studies | No studies |
Cost implications of antibiotic provision | The study did not provide any data on mortality, adverse events requiring hospitalisation, adverse effects of antibiotics or cost implications of treatment. | 0 studies | No studies |
Development of endocarditis (in those with definite indication for prophylaxis) within 180 days · Definite indication for prophylaxis | OR 1.62 [0.57, 4.57] | 1 study · 248 participants | Very low Downgraded: risk of bias, imprecision |
Antibiotic prophylaxis before dental procedure vs No antibiotic prophylaxis or placebo
Population: Adults or children at increased risk of bacterial endocarditis (pre-existing cardiac condition) undergoing an invasive dental procedure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality | Mortality | 248 (1 study) | - | No mortality data reported | 0 studies | No studies |
Development of endocarditis (in those with definite indication for prophylaxis) within 180 days · Definite indication for prophylaxis | OR 1.62 [0.57, 4.57] | 1 study · 248 participants | Very low Downgraded: risk of bias, imprecision |
Development of endocarditis due to other (non-dental) causes | Only four cases developed endocarditis following non-dental medical interventions (within the past 180 days and with pre-existing cardiac indications for the use of prophylaxis), so assessment of the effects of… | 0 studies | No studies |
Adverse events | Adverse events | 248 (1 study) | - | No adverse event data reported | 0 studies | No studies |
Cost implications of antibiotic provision | No studies were located that assessed mortality, serious adverse events requiring hospital admission, other adverse events or cost implications of treatment. | 0 studies | No studies |
Antibiotic prophylaxis before dental procedure vs No antibiotic prophylaxis or placebo
Population: Adults or children at increased risk of bacterial endocarditis (pre-existing cardiac condition) undergoing an invasive dental procedure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Development of endocarditis due to other (non-dental) causes | Only four cases developed endocarditis following non-dental medical interventions (within the past 180 days and with pre-existing cardiac indications for the use of prophylaxis), so assessment of the effects of… | 0 studies | No studies |
Development of endocarditis (following invasive dental procedure) within 180 days · Definite indication for prophylaxis | OR 1.62 [0.57, 4.57] | 1 study | Ungraded |
Mortality or serious adverse events requiring hospital admission | No studies were located that assessed mortality, serious adverse events requiring hospital admission, other adverse events or cost implications of treatment. | 0 studies | No studies |
Any recorded adverse events to the antibiotics | No studies were located that assessed mortality, serious adverse events requiring hospital admission, other adverse events or cost implications of treatment. | 0 studies | No studies |
Cost implications of antibiotic provision | No studies were located that assessed mortality, serious adverse events requiring hospital admission, other adverse events or cost implications of treatment. | 0 studies | No studies |
Penicillin prophylaxis before dental procedure vs No penicillin administration or placebo
Population: Adults or children at increased risk of bacterial endocarditis (pre-existing cardiac condition) undergoing an invasive dental procedure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Development of endocarditis due to other (non-dental) causes | Only four cases developed endocarditis following non-dental medical interventions (within the past 180 days and with pre-existing cardiac indications for the use of prophylaxis), so assessment of the effects of… | 0 studies | No studies |
Cost implications of antibiotic provision | No studies were located that assessed mortality, serious adverse events requiring hospital admission, other adverse events or cost implications of treatment. | 0 studies | No studies |
Development of endocarditis (following invasive dental procedure) within 180 days · Definite indication for prophylaxis | OR 1.62 [0.57, 4.57] | 1 study | Ungraded |
Mortality or serious adverse events requiring hospital admission | No studies were located that assessed mortality, serious adverse events requiring hospital admission, other adverse events or cost implications of treatment. | 0 studies | No studies |
Any recorded adverse events to the antibiotics | No studies were located that assessed mortality, serious adverse events requiring hospital admission, other adverse events or cost implications of treatment. | 0 studies | No studies |
Penicillin prophylaxis before dental procedure vs No penicillin administration or placebo
Population: Adults or children at increased risk of bacterial endocarditis (pre-existing cardiac condition) undergoing an invasive dental procedure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Any recorded adverse events to the antibiotics | no estimate extracted | 0 studies | No studies |
Mortality or serious adverse event requiring hospital admission | no estimate extracted | 0 studies | No studies |
Cost implications of antibiotic provision | no estimate extracted | 0 studies | No studies |
Development of endocarditis due to other (non-dental) causes | no estimate extracted | 0 studies | No studies |
Development of endocarditis following any dental procedure in a defined time period defined time period | no estimate extracted | 0 studies | No studies |