Antibiotic prophylaxis of infective endocarditis in oral and maxillofacial surgery: incomplete implementation of guidelines in everyday clinical practice

Abstract

Infective endocarditis (IE) is a devastating disease with high mortality. Most guidelines recommend routine use of antibiotic prophylaxis during oral surgery to prevent IE in patients with specific predisposing cardiac conditions, but this is not the case in the UK. The conflicting opinions and guidance are confusing and may affect IE prophylaxis implementation. We investigated how IE prophylaxis standards are defined in hospitals and outpatient clinics of oral and maxillofacial surgery. A survey was sent to 80 surgeons heading departments of oral and maxillofacial surgery in Germany. We observed significant heterogeneity in IE prophylaxis implementation among the clinics. This diversity was in relation to the definition of predisposing cardiac conditions, the type of dental and surgical procedures performed that require IE prophylaxis, the spectrum of compounds used, and the timing of antibiotic prophylaxis. We observed under-prescription of IE prophylaxis in high-risk patients, the overuse of antibiotic prophylaxis in patients not at high risk of IE, and the use of inappropriate drugs. These findings suggest that educational strategies and guideline implementation advice are needed to improve standards of IE prophylaxis in oral and maxillofacial surgery clinics.