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Antibiotics for Prevention of Endocarditis during Dentistry: Time To Scale Back?

David T. Durack, MB, DPhil
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Becton Dickinson Microbiology Systems; Baltimore, MD Requests for Reprints: David T. Durack, MB, DPhil, Becton Dickinson Microbiology Systems, 7 Loveton Circle, Sparks, MD 21152-0999.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;129(10):829-831. doi:10.7326/0003-4819-129-10-199811150-00015
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Antibiotics should be given to prevent endocarditis when a predisposed patient undergoes dental treatment. This 50-year-old doctrine is based on a logical premise: Dental procedures induce bacteremias with bacterial species that often cause endocarditis, and endocarditis carries high morbidity and mortality; therefore, antibiotics should be administered to susceptible patients before dental procedures to prevent endocarditis [1]. Furthermore, antibiotics definitely can prevent endocarditis in experimental animals [13]. On these grounds, prophylaxis against endocarditis is widely recommended [1, 4]. Although compliance has been less than perfect [5] and apparent failures of prophylaxis are not rare [6], the practice is now so entrenched that failure to give prophylaxis has generated many malpractice claims [7]. However, its effectiveness in humans, let alone its cost-effectiveness, has not been proven and probably never will be [1].

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