Search

Objective: The main aim of this study was to assess dentists' compliance with current guidelines of antibiotic prophylaxis of Infective Endocarditis (IE) in France. Methods: A national survey was carried out, using a questionnaire developed in collaboration with the Association for the Study and Prevention of Infective Endocarditis (AEPEI). An electronic survey of 136 questions was sent out from September to October 2012 to the 12,000 practitioners who were members of the French Union for Oral Health (UFSBD). Results: 906 practitioners answered the questionnaire and 530 fully completed it. 94% of dentists declared managing patients at risk of IE; however, only 57% properly identified the publication date of the current guidelines promoted by the National Agency for Medicinal and Health Product Safety (ANSM) in 2011. This study highlighted a lack of knowledge of the respondents about the currently recommended management of patients at risk of EI, whether for the assessment of the risk of IE, its prevention or the follow-up of patients with predisposing cardiac conditions. Practitioners were not aware of their lack of knowledge: 59% declared that they had a good or a very good knowledge of these guidelines, but only 13% correctly assessed the risk of developing IE, 3% really knew the allowed or contraindicated procedures in patients at risk of IE, and only 22% had an appropriate drug prescription plan. In addition, there was a lack of the practitioners' compliance with the current guidelines. Only 41% declared having modified their practice according to these guidelines and only 16% had adapted their frequencies. Two major reasons for this lack of compliance were identified by this survey: the low level of scientific evidence to support these guidelines, and a huge evolution in the pathogenesis of IE. Finally, three-quarters of the respondents still wrongly prescribed an antibiotic prophylaxis to patients with moderate risk of EI. Nevertheless, comparing these results with those of two similar previous surveys in 1991 and 2001, the implementation of guidelines has globally improved in 20 years. Conclusions: The compliance with the guidelines on management of patients at risk of IE could be improved. The apparent stability of the incidence of oral streptococci IE in France since the reduction of the antibiotic prophylaxis indications in 2002 could reflect more the lack of the practitioners' compliance than a real efficacy of the current prevention strategies. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Antibiotic prophylaxis for infective endocarditis is still debated because of unproven efficacy and risk of side effects. French recommendations for infective endocarditis prophylaxis were revised in 2002 and its indications were restricted. Current knowledge and key points: Several arguments plead against prophylaxis: the absence of scientific evidence of its efficacy, the very high number of antibiotic doses required to prevent a very small number of endocarditis, the possible failure of prophylaxis even if correctly administered and a lack of compliance with current recommendations. High-risk patients for whom dental extraction is required should receive prophylaxis. For moderate-risk patients, prophylaxis is optional and should be discussed for each case individually. Future prospects and projects: Although prophylaxis is discussed, one should focus on prevention measures, such as dental hygiene and education of physicians, dentists and patients. [Copyright &y& Elsevier]