Antibiotic Prophylaxis

Question 1

What are the indications for AB prophylaxis?

Answer 1

Procedure has a high infection rate

Antibiotic prescribed to prevent bacterial contamination of procedure site

High mortality rate if there is an infection

Use of foreign body

Question 2

What is infective endocarditis?

Answer 2

Inflammatory process that affects the endocardium and may have infective or non infective origin

Question 3

Why is it important to prevent infective endocarditis?

Answer 3

It is a rare but severe disease with in-hospital mortality rate of 20% and 5 year mortality rate of 40%

Associated with high morbidity and a high cost burden

Question 4

What causes bacteremia that can lead to infective endocarditis with people predisposed to it?

Answer 4

Extractions

Poor oral hygiene

Other dental procedures

Question 5

Which patients need to be given antibiotic prophylaxis?

Answer 5

Prosthetic cardiac valve

Previous infective endocarditis

Congenital heart disease with unrepaired cyanotic heart defects (including palliative shunts and conduits) or with repaired defect with residual defects at or adjacent to the site of a prosthetic patch or device

Prosthetic material used for cardiac valve repair such as annuloplasty rings and chords

Rheumatic heart disease

Question 6

Should antibiotic prophylaxis be prescribed for patients with prosthetic joint (hip, shoulder or knee) replacemetns?

Answer 6

Yes

Question 7

Should antibiotic prophylaxis be prescribed for patients with prosthetic joint (hip, shoulder or knee) replacements?

Answer 7

This isn’t on the therapeutic guidelines as an indication, however this should be discussed with the orthopedic surgeon. Also no clear connection between oral bacteria and infection of prosthetic joints.

Question 8

Is MRONJ an indication for antibiotics?

Answer 8

Some evidence of decreased incidence of MRONJ if antibiotics are taken with bisphosphonates