Title	Lack of Evidence for Effectiveness of Antibiotics for SBE Prophylaxes Prior to Invasive Dental Treatment
Clinical Question	In a patient with a history of heart murmur, how does the use of antibiotics compare to placebo with regards to SBE prophylaxes before an invasive dental procedure?
Clinical Bottom Line	There was no difference between antibiotics VS placebo prophylaxis prior to invasive dental procedures in preventing SBE. (See Comments on the CAT below)
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 18843649 Worthington/2008 One case control study included Systematic Reveiw Key results This study included 349 patients in the Netherlands, who developed endocarditis following a dental procedure over a 2-year period. Patients were eligible if they had congenital heart disease, co-arctation of the aorta, rheumatic or other valvular dysfunction or mitral valve prolapse. Results indicate the odd ratio (OR) of developing endocarditis in those receiving antibiotic vs. placebo was 1.62, 95% confidence level 0.57 to 4.57, which means it wasn’t significantly different.
Evidence Search	Search "Antibiotic Prophylaxis"[Mesh]Search "Endocarditis"[Mesh]
Comments on The Evidence	A Cochrane review analyzing antibiotic prophylaxis VS placebo was done. In this review 2 authors searched the database from 1950 to 2008 for RCT, CCT, cohort studies and case studies in an effort to look for the strongest evidence. Analysis of quality was based on the assessment of Downs and Black and included external and internal validity. Out of 980 articles identified, no RCT, CCT or cohort studies were identified. Only 3 control studies were identified, 2 of which were deemed extremely biased and were eliminated. The authors suggest that there is an extreme lack of evidence to support the AHA guidelines published in 2007 and more research is needed to identify the pros and cons of antibiotic prophylaxes. Their results however show that there is no significant difference between the the cases and the controls. Overuse of antibiotics is a dangerous issue with several side effects and ineffective use of antibiotics should be avoided.
Applicability	This study is applicable since subjects are reflective of patients seeking dental treatment at any practice. Antibiotic prophylaxis would be a feasible procedure for any dentist.
Specialty	(Public Health) (Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry) (Oral Surgery) (Orthodontics) (Periodontics) (Prosthodontics) (Restorative Dentistry) (Behavioral Science)
Keywords	Endocarditis, antibiotic, prophylaxis
ID#	837
Date of submission	04/28/2011
E-mail	Sabbah@uthscsa.edu
Author	Ahmed Sabbah
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Bjorn Steffensen, DDS
Faculty mentor e-mail	SteffensenB@uthscsa.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?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Blaine Calahan & Roger Arredondo (San Antonio, TX) on 10/15/2014 An updated Cochrane systematic review from 2013 by the same group of authors reports the same findings: There is no significant difference between antibiotic prophylaxis vs placebo (no antibiotic) prior to invasive dental procedures in preventing SBE. Mang-de la Rosa MR, 2014 discussed medico-legal services advising dentists to follow the reported guidelines of their organizations such as ADA, IDSA, and PIDS in the United States and other countries to prescribe antibiotic prophylaxis in high risk patients such as those having a previous history of bacterial endocarditis, prosthetic heart valve, or congenital heart abnormalities.