Latest revision to Adult Antimicrobial Prescribing
Revised guidance on antimicrobial prescribing in infective endocarditis
Issues concerning current general guidance
The following information updates pages 28 and 32-36 of the FGDP(UK) publication Adult Antimicrobial Prescribing in Primary Dental Care for General Dental Practitioners. However, it should be noted that since this information was published, the situation regarding consensus for antimicrobial prophylaxis in endocarditis has become unclear.
In light of a letter from the Chief Dental Officer to all dentists (dated 22 June 2006) in which this issue is referred to, as well as recent comment from the dental protection societies, it is possible that clinical thinking in this area may be further revised in due course.
Updated information will be published here as it becomes available. In the meantime, practitioners should continue to seek guidance from all available sources, both in print and online.
Update to the FGDP(UK)'s guidance
In April 2006, the British Society for Antimicrobial Chemotherapy (BSAC) issued new guidance on the prevention of infective endocarditis, replacing the previous BSAC recommendations published in the British National Formulary (BNF).
As a result, the FGDP(UK) has updated information on infective endocarditis within the faculty's publication
Adult Antimicrobial Prescribing in Primary Dental Care for General Dental Practitioners.
 View the updated information for pages 32-36
The guidance states that the only patients requiring antibiotic prophylaxis for dental treatment are:
- Those who have had infective endocarditis
- Those who have prosthetic heart valves
- Those who have a surgically constructed systemic pulmonary shunt or conduit
There is no longer a need to refer the above groups of patients for intra-venous antibiotics as the oral route is now acceptable. All dental procedures for these patients involving dentogingival manipulation and endodontic treatment require antibiotic prophylaxis.
Update to Table 1 on page 28
The table on page 28 of the publication has also been updated as a result of the new guidance.
Under the column headed 'Endocardial disease', all the dental procedures listed should now read 'Yes', indicating that antimicrobial prophylaxis is now recommended for the three groups listed above when undergoing sutre removal, root canal obturation, and matrix bands, crowns and impressions, in addition to the other procedures listed.
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