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Is penicillin prophylaxis effective against bacterial endocarditis?

机译：青霉素预防对细菌性心内膜炎有效吗？

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DATA SOURCES: Cochrane Oral Health, Heart and Infectious Diseases Groups' Trials Registers Cochrane Central Register of Controlled Trials (CENTRAL) OLDMEDLINE; EMBASE SIGLE (to June 2002); and the Meta-register of current controlled trials. STUDY SELECTION: Due to the low incidence of BE a low yield of trials was expected so cohort and case-controlled studies were included where suitably matched control or comparison groups had been studied. The intervention was the administration of penicillin compared to no such administration before a dental procedure in people with an increased risk of BE. Outcomes of interest were: mortality or serious adverse event requiring hospital admission; development of endocarditis following any dental procedure in a defined time period; development of endocarditis due to other non-dental causes; any recorded adverse events to the antibiotics; and cost implications of the antibiotic provision for the care of those patients who develop endocarditis. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently selected studies for inclusion, then assessed quality and extracted data from the included study. RESULTS: One case-control study met the criteria. This study included participants who died because of the endocarditis (using proxys). It collected all the cases of endocarditis in the Netherlands over 2 years, finding 24 people who developed endocarditis within 180 days of an invasive dental procedure. Controls attended local cardiology outpatient clinics for similar cardiac problems, had undergone an invasive dental procedure within the past 180 days and were matched by age with the cases. No significant effect of penicillin prophylaxis on the incidence of endocarditis could be seen. No data were found on other outcomes. CONCLUSIONS: There is no evidence about whether penicillin prophylaxis is effective or ineffective against bacterial endocarditis in people at risk who are about to undergo an invasive dental procedure. There is a lack of evidence to support published guidelines in this area. It is not clear whether the potential harms and costs of penicillin administration outweigh any beneficial effect. Ethically practitioners need to discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about administration.
机译：数据来源：Cochrane口腔健康，心脏和传染病小组的试验登记册Cochrane对照试验中央登记册（CENTRAL）。 EMBASE SIGLE（至2002年6月）;以及当前对照试验的Meta寄存器。研究选择：由于BE的发生率低，因此预计试验的产率较低，因此，在进行了适当匹配的对照组或比较组的研究中，包括了队列研究和病例对照研究。与BE风险增加的人进行牙科手术之前不进行青霉素相比，干预是青霉素的给予。令人感兴趣的结果是：需要住院的死亡率或严重不良事件;在规定的时间段内进行任何牙科手术后都会发生心内膜炎;由于其他非牙科原因导致的心内膜炎的发展;任何记录的对抗生素的不良事件;抗生素治疗患有心内膜炎的患者的费用和费用影响。数据提取和合成：两位评价员独立选择纳入研究，然后评估质量并从纳入研究中提取数据。结果：一项病例对照研究符合标准。这项研究包括因心内膜炎而死亡的参与者（使用代理人）。它收集了荷兰两年内的所有心内膜炎病例，发现有24个人在侵入性牙科手术后180天内发生了心内膜炎。对照组在当地心脏病门诊就诊，遇到类似的心脏问题，在过去180天内进行了侵入性牙科手术，并根据年龄与病例相匹配。预防青霉素对心内膜炎的发生没有明显影响。未找到其他结果的数据。结论：尚无证据表明青霉素预防对即将进行侵入性牙科手术的高危人群细菌性心内膜炎有效或无效。缺乏支持该领域已发布指南的证据。尚不清楚青霉素给药的潜在危害和成本是否超过任何有益效果。从伦理上讲，从业人员需要与患者讨论抗生素预防的潜在利弊，然后才能做出给药决定。

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