 |
| Title |
Insufficient Evidence supporting the use of Antibiotic Prophylaxis in Solid Organ Transplant Patients Prior to Dental Treatment |
| Clinical Question |
Do Patients with Solid Organ Transplants require Antibiotic Prophylaxis before Dental Treatment to prevent sepsis or distant bacteremia? |
| Clinical Bottom Line |
There is limited evidence supporting the use of prophylactic antibiotics among patients with solid organ transplants before dental procedures. Decisions about antibiotic prophylactic therapy should be made on an individualized basis after discussing patient history and planned dental treatment with the patient’s physician. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 22260809 | Stoopler/2012 | Organ Transplant recipients | Review | | Key results | Routine administration of antibiotic prophylaxis to patients with solid organ transplants before invasive dental treatment is not recommended, and a discussion with the patient’s physician/transplant physician should be undertaken to make a decision. However, antibiotic prophylaxis is recommended for patients with cardiac transplants consistent with the American Heart Association guidelines. | | #2) 12686921 | Guggenheimer/2003 | Organ Transplant recipients | Review | | Key results | Premedication prior to dental treatment is usually recommended however there need to be guidelines created hinging upon evidence-based data which is currently lacking in this topic. They, however, stated that since there is a significant risk of bacteremia arising from invasive dental procedures that prophylactic antibiotics are usually recommended. | | #3) 15659128 | Guggenheimer/2005 | US Transplant Centers | Survey | | Key results | A survey regarding dental care protocols sent to US transplant centers portray that 83% of medical and/or surgical directors that responded routinely request antibiotic prophylaxis prior to dental treatment. The overall response rate of this survey was 38%, thereby their results did not represent a consensus. | | #4) 22260809 | Vasanthan/2007 | Organ Transplant recipients | Review | | Key results | It is important to coordinate with physicians when planning dental treatment for organ transplant patients about the use of antibiotic prophylaxis prior to invasive dental treatment. Empirical use of premedication prior to invasive dental treatment is advocated in the case of transplant patients. | |
| Evidence Search |
“Antibiotic prophylaxis”[MeSH], “Dental care” [MeSH], “Organ transplantation”[MeSH] |
Comments on
The Evidence |
Guidelines about antibiotic prophylaxis prior to dental treatment are constantly being changed and adapted according to new research. Currently, the indication to use antibiotic prophylaxis for solid organ transplant patients is limited since there is no evidence-based data from controlled clinical trials. The perceived advantages to antibiotic prophylaxis would be the prevention of sepsis or distant bacteremia.
The benefits and potential adverse effects need to be weighed in each patient in order to determine whether or not antibiotic prophylaxis prior to dental treatment is an appropriate therapy by consulting with the patient’s physician or transplant specialist.
|
| Applicability |
Organ transplantation is a rapidly developing medical field. The dentist needs to be informed on the management protocol for patients who receive these organ transplants. Currently, there are no strong guidelines that support the use of antibiotic prophylaxis prior to an invasive dental procedure. Good communication between the patient’s oral health care provider, primary physician and specialists is beneficial for overall care of these patients. |
| Specialty/Discipline |
(Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry) (Oral Surgery) (Pediatric Dentistry) (Periodontics) (Restorative Dentistry) (Dental Hygiene) |
| Keywords |
Antibiotic prophylaxis, Solid organ transplant, Infection
|
| ID# |
2484 |
| Date of submission: |
05/08/2013 |
| E-mail |
amana.farrkh@ucdenver.edu |
| Author |
Amana Farrkh |
| Co-author(s) |
|
| Co-author(s) e-mail |
|
| Faculty mentor/Co-author |
Pallavi Parashar, BDS, DDS |
| Faculty mentor/Co-author e-mail |
Pallavi.parashar@ucdenver.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
|
|
