The Faculty of General Dental Practice UK (FGDP(UK)) has responded to a consultation on draft advice for dentists on the prophylactic use of antibiotics against infective endocarditis (IE).
The Scottish Dental Clinical Effectiveness Programme (SDCEP) is developing ‘implementation advice’, which dentists throughout the UK would be expected to adhere to, following the revision in 2015 of NICE Clinical Guideline 64 (CG64).
The key messages of the original NICE guidance, published in 2008, were that antibiotic prophylaxis should not be used for dental procedures to prevent IE, and that patients at increased risk of IE be advised of the importance of oral health. The revised guidance states that prophylaxis should not be used ‘routinely’ for dental patients at increased risk of IE, and in 2016 NICE clarified that this change was to reflect a healthcare professional’s duty to apply their clinical judgement while taking into account guidelines and patient preferences.
SDCEP is seeking to provide further clarification of the non-routine circumstances in which antibiotic prophylaxis to prevent IE might be justified, but acknowledges that there is no convincing evidence for the effectiveness of antibiotic prophylaxis for preventing IE, and that the risk of IE from all causes is in any case extremely low.
FGDP(UK) believes the present degree of confusion within the profession to be overstated, but is concerned that the proposed categorisation of patients into ‘increased risk’ and ‘highest risk’ groups – a distinction not present in CG64 - could if anything increase confusion.
The Faculty has also expressed concern at the absence of any reference to the risks of antimicrobial resistance, which dentists should discuss with patients if they are considering prescribing prophylactic antibiotics to prevent IE.
The FGDP(UK)’s Antimicrobial Prescribing For General Dental Practitioners reflects CG64, and provides evidence-based guidance for prudent prescribing and antimicrobial stewardship. It is available as an e-book, freely online, and in hard copy at www.fgdp.org.uk/shop. Members can purchase the hard copy at a discount by logging in to the website.
The full consultation response is available at https://www.fgdp.org.uk/policy-reports-and-consultations.
SDCEP is also conducting an online survey of dentists’ prophylactic use of antibiotics, which is open until the end of February 2018 and available here.