Endocarditis prophylaxis in children and adolescents: indications in consideration of the dental treatment setting
摘要
This study aimed to evaluate the administration of endocarditis prophylaxis (EP) in children and adolescents with cardiac findings requiring invasive dental therapy according to the newest European Society of Cardiology (ESC) guidelines from 2023. The research question focused on comparing EP protocols between chairside treatment (CS) and general anesthesia (GA) settings, given clinical protocol differences observed between these modalities. This retrospective analysis included 201 patients with cardiac findings who attended the Department of Pediatric Dentistry at Giessen University Hospital between 2018 and 2023 and underwent dental interventions with bacteremia risk. Patient data included cardiac findings, EP administration protocols, antibiotic agents used, treatment settings, and patient outcomes defined as infective endocarditis (IE) occurrence within three months post-intervention. EP indications were evaluated according to ESC guidelines. Fisher’s exact test was used to statistically test differences (GA vs. CS) regarding the outcome and the type of EP medication (α = 0.05). Of all patients, 58.7% received treatment under GA and 41.3% chairside. According to ESC guidelines, EP indication existed in 36.4% of GA patients and 22.9% of CS patients. However, EP was administered in 84.7% of GA patients and 59.0% of CS patients. A significant correlation was found between the variables “treatment setting” and “antibiotic preparation EP” (p < 0.001). No cases of IE occurred within 3 months, regardless of EP administration or indication status.
Conclusion: Besides the limitations of our retrospective study, frequent EP over-administration beyond guideline recommendations was detected, and no IE cases occurred. This aspect could question whether EP indications should be more restrictively defined, particularly in children and adolescents with healthy dental status.