The Faculty of General Dental Practice UK (FGDP(UK)) has endorsed new advice for dentists on the prophylactic use of antibiotics against infective endocarditis (IE).
Following the revision in 2016 of the National Institute for Health and Care Excellence’s Clinical Guideline 64 (NICE CG64), the Scottish Dental Clinical Effectiveness Programme (SDCEP) has published implementation advice, the crux of which is that:
“The vast majority of patients at increased risk of infective endocarditis should not be offered prophylaxis. However, for a very small number of patients [‘Patients Requiring Special Consideration’], it may be prudent to consider antibiotic prophylaxis in consultation with the patient and their cardiologist or cardiac surgeon”.
Earlier this year, the Faculty raised some concerns when the advice was in development. However, a number of improvements have been made as a result of feedback from FGDP(UK) and other organisations, and the Faculty now supports the finalised guidance - which has also been endorsed by NICE - and says dentists throughout the UK will find it useful.
NICE CG64 states that antibiotic prophylaxis is not recommended ‘routinely’ for invasive dental procedures, and the new SDCEP advice aims to clarify the non-routine circumstances in which antibiotic prophylaxis to prevent IE from such procedures might be justified. It is accompanied by a patient management flowchart, a discussion points document for use with patients, and a patient advice leaflet, and also includes a template letter for use when contacting a patient’s cardiology consultant or cardiac surgeon.
Dr Nick Palmer, Editor of the FGDP(UK)’s Antimicrobial Prescribing For General Dental Practitioners – which reflects NICE CG64 and provides evidence-based guidance for appropriate antimicrobial prescribing and stewardship – commented:
“For over ten years the recommendations in NICE CG64, which apply to all healthcare professionals including cardiologists, have remained the same. These are that patients at increased risk of IE should be advised of the risks and benefits of prophylaxis, and that antibiotic prophylaxis is not routinely required for invasive dental procedures. The patient should also be advised of the symptoms of IE, of the importance of maintaining good oral health to reduce their risk of IE, and when to seek expert advice.
“SDCEP’s implementation advice re-emphasises the NICE CG64 recommendations, but notes that there are a very small number of dental patients that may require ‘special consideration’ for antibiotic prophylaxis. Importantly, SDCEP's implementation advice shifts the balance of responsibility for the decision on antibiotic prophylaxis for these patients from the dentist to the patient’s cardiologist and to the patient under Montgomery consent. Dentists should ensure they record in the clinical notes any advice from the patient’s cardiologist, and the patient's consent when a decision is made."
Antimicrobial Prescribing for General Dental Practitioners is available as an e-book, freely online and in hard copy at www.fgdp.org.uk/shop. FGDP(UK) members can purchase the hard copy at a discount by logging in to the website.