Discontinuation of antibiotics before dental procedures linked to increase in heart valve infection

iStock Heartbeat for WEB Discontinuation of antibiotics before dental procedures linked to increase in heart valve infectionCutting back on the use of antibiotics before dental work may be to blame for an increase in heart valve infection in patients in England, a new study finds.

Certain dental procedures can stir up the bacteria in the mouth and cause them to enter the bloodstream, where they can travel to the heart and cause a life threatening infection known as endocarditis. The heart problem kills 10-20 percent of those infected. People with artificial heart valves and other implants are at high risk of becoming infected with endocarditis, and those with naturally leaky heart valves, called mitral valve prolapse, are at moderate risk.

To help protect these patients from becoming ill, dentists routinely give antibiotics, typically a single dose of penicillin, just before dental procedures. There was little evidence that this preventative treatment served any good, and in some cases the penicillin could cause serious allergic reactions. Furthermore, overuse of antibiotics has become a growing issue and increases the risk of drug resistant germs.

Due to these concerns, the American Heart Association in 2007 issued a statement saying that preventative antibiotics should only be used in patients at high risk of infection. Soon after, medical experts in England recommended discontinuing the practice in all patients.

Researchers from the University of Surrey and Oxford University decided to pore through data to see if dentists were discontinuing preventative antibiotic use before dental procedures and if so, to see if it had an impact on rates of endocarditis.
Researchers found that the use of preventative antibiotics dropped from an average of nearly 11,000 per month in the four years prior to the new recommendations to just 2,236 per month in the five years after the recommendations were made.

Shockingly, the number of heart valve infections began to rise. Five years after dentists cut back on preventative antibiotic use, there were about 35 additional endocarditis cases per month.

Researchers are quick to point out that the study does not prove that fewer antibiotics are to blame for the increase in cases of endocarditis. Heart infections have been on the rise in other countries as implantable medical devices and kidney dialysis have become more common. However, the results encourage further study.

Source: PharmPro