Sun14November1246PM 21

A 45-year-old patient is scheduled for some dental extractions under general anaesthesia. He informs you that he has a heart murmur and on previous visits to the dentist has always received antibiotic prophylaxis. He has no known allergies.

Which is the most appropriate approach to antibiotic prophylaxis for this patient?

(Please select 1 option)

Prophylactic antibiotics are unnecessary for this patient Correct

Prophylactic antibiotics are avoided to prevent bacterial resistance

Prophylaxis to cover Gram +ve and Gram -ve organisms is required

Give an oral dose of an appropriate antibiotic preoperatively

Give an intravenous dose of an appropriate antibiotic at induction

Explanation

The National Institute for Health and Care Excellence (NICE) have produced guidelines on the prophylaxis against infective endocarditis (IE). The focus was on developing clear guidance on best practice for antibiotic prophylaxis in patients having dental procedures and certain non-dental interventional procedures. For dental and non-dental procedures a number of studies have shown an inconsistent association between recent interventional procedures and the development of infective endocarditis.

Antibiotic prophylaxis against infective endocarditis is not recommended and is unnecessary for the following:

Patients undergoing dental procedures

Patients undergoing procedures to the upper and lower gastrointestinal tract, genitourinary tract (including urological, gynaecological and obstetric procedures, and childbirth), and

Patients undergoing procedures to the upper and lower respiratory tract (including ear, nose and throat procedures and bronchoscopy).

The indiscriminate use of prophylactic antibiotics has the potential to reduce the incidence of antibiotic resistance but is not the primary reason for avoiding their use in these circumstances.

However, any patient that is at risk of developing IE should be investigated and treated promptly to reduce the risk of endocarditis developing. Patients at risk of developing IE include those with:

acquired valvular heart disease with regurgitation or stenosis

previous valve replacement

structural congenital heart disease

past history of IE, or

hypertrophic cardiomyopathy (HOCM).

Reference:

NICE. Prophylaxis against infective endocarditis (CG64).

Answer Statistics

1

78%

2

6%

3

5%

4

5%

5

9%

Times answered: 275