Guideline update for infective endocarditis successful

By Piriya Mahendra

The incidence of infective endocarditis did not increase after American guidelines for antibiotic use before dental procedures were updated in 2007, a report in Circulation shows.

The national annual infective endocarditis diagnosis rates declined from approximately 15,300-17,400 between 1999 and 2006 to approximately 14,700-15,500 between 2007 and 2009, after the guidelines were updated.

In 2007, the American Heart Association changed its guidelines on infective endocarditis prevention, recommending that doctors prescribe antibiotics to patients before invasive dental procedures only if at risk for complications from infective endocarditis. This includes patients with artificial heart valves, transplanted hearts with abnormal heart valve function, previous infective endocarditis, and people born with heart defects.

"[Before 2007] we were giving preventive antibiotics like we were treating an entire iceberg, when we only needed to treat the very tip of that iceberg," said lead author Daniel DeSimone (Mayo Clinic, Rochester, Minnesota, USA) in a press statement. "Millions of people once getting antibiotics now are not."

From January 1999 to December 2010, 22 patients in Olmsted County, Minnesota, USA were diagnosed with infective endocarditis. These patients represented two to three of every 100,000 individuals in the USA before the guideline update and one of every 100,000 after the guideline update, the authors report.

"These findings are reassuring, but additional studies are needed to further support our findings," DeSimone remarked.

"There's still a concern among many healthcare providers over whether we are leaving certain people at risk of getting a potentially lethal infection just from a dental cleaning or tooth extraction," he added.

"This study should reduce some fears. It will allow dentists to become more comfortable when they tell a patient 'You've been getting this antibiotic for years. Now, it's not recommended anymore, and here is data showing you why.'"

For the study, DeSimone and team analyzed local hospital discharge rates in the Rochester Epidemiology Project and national rates using the Nationwide Inpatient Sample.

The authors point out that due to the lack of racial diversity in Olmsted County, their results may not apply to nonCaucasian populations.

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