The newsLINK Group - Antibiotic Prophylaxis

Editorial Library Category: General Business | Dental | Periodontist – Gum Disease Topics: Antibiotic Prophylaxis Title: Antibiotic Prophylaxis Author: newsLINK Staff Synopsis: The reasoning behind prescribing a course of antibiotic prophylaxis has to do with prevention: invasive dental procedures can introduce bacteremias in some patients who are already at-risk, resulting in creation of a new and extremely serious medical problem after the original operation or treatment. Editorial: Antibiotic Prophylaxis 4064 South Highland Drive, Millcreek, Utah 84124 │ thenewslinkgroup.com │ (v) 801.676.9722 │ (tf) 855.747.4003 │ (f) 801.742.5803 Editorial Library | © The newsLINK Group LLC 1 The reasoning behind prescribing a course of antibiotic prophylaxis has to do with prevention: invasive dental procedures can introduce bacteremias in some patients who are already at-risk, resulting in creation of a new and extremely serious medical problem after the original operation or treatment. Many dentists are particularly concerned about preventing infective endocarditis. The bacteremia that can lead to infective endocarditis is never normal. It can occur as a result of surgery or the introduction of foreign bodies, such as catheters, but it can also be caused by something as mundane as a patient’s daily habit of brushing and flossing. As the immune system responds to the threat posed by the bacteremia, one potential result can be sepsis shock. Sepsis shock is serious enough to kill someone, which is bad enough, but since a patient with sepsis shock is likely to receive medical treatment in an intensive care unit, the medical care is also expensive and could be financially ruinous. Some have argued that a standard of care involving use of antibiotic prophylaxis has developed not because it is scientifically justified but for medicolegal reasons — or, in plainer English, as a defensive maneuver in case some patient decides to take the dentist or specialist to court. Maybe this particular defense was sensible enough in the past, both medically and legally, if a patient was otherwise healthy. But prescribing antibiotics for a patient when there is no evidence of an actual infection can be considered controversial if the patient has an orthopedic prosthetic device, immunosuppressed host defenses, or indwelling catheters. And, in point of fact, there is no scientific proof to support the idea that antibiotic prophylaxis is an effective preventive measure for someone with underlying risk factors for heart disease. There are many reasons why a patient’s host defenses may be impaired. For example, the patient might be: Someone who has received an organ transplant or a tissue graft. Someone who has undergone chemotherapy. A diabetic whose diabetes is not well controlled. An alcoholic. For all these types of patients, determining the white cell count is helpful before deciding whether to prescribe a course of antibiotics. A normal level is 4,000 to 11,000. For a patient whose white cell count is less than 2,500, the patient may in fact benefit from antibiotic prophylaxis. The exception would be a patient who has AIDS. AIDS has opportunistic pathogens that are generally not susceptible to antibiotics being used as a prophylaxis. Prescribing a course of antibiotics anyway is more likely than usual to cause the development of microorganisms that are resistant to antibiotics … leading directly to a possible superinfection. Preventing Infective Endocarditis In April 2007, the American Heart Association significantly changed its guidelines for preventing infective endocarditis. Their changes were based on changes recommended by the American Dental Association. The changes reflect the reality of a downward shift on the benefit side of a risk-benefit analysis. As it has become obvious that the medical practice of generously prescribing antibiotics may destroy the effectiveness of this particular tool, medical practitioners everywhere are taking a step back and reevaluating their use of antibiotics in all medical situations. Even though it has not been scientifically established whether using antibiotic prophylaxis is effective, it is still reasonable to try and protect those patients who are at greatest risk from specific cardiac conditions and who might therefore benefit from antibiotic prophylaxis. At-risk patients are defined as followed: Those who have artificial heart valves. Those who have had infective endocarditis in the past. Someone who has had a heart transplant where the new heart has developed a valve problem. Someone with specific congenital heart problems.

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