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The findings of Al-Karaawi and colleagues in the present issue are disturbing.1 One may conclude from their work that antibiotic prophylaxis against infective endocarditis should be applied more largely for dental procedures for which guidelines usually do not recommend such prophylaxis. At the same time, the usefulness of antibiotic prophylaxis is debated by many authors.2 ,3Fortunately, prophylaxis is still recommended by authors who debate about it, and Al-Karaawi and colleagues do not draw the conclusion suggested above.
Antibiotic prophylaxis and dental treatments: to be extended to more patients?
In 136 children with severe congenital cardiac disease who underwent dental procedures, Al-Karaawi and colleagues calculated a cumulative exposure to bacteraemia over one year for several dental procedures, which were considered as prophylaxis or non-prophylaxis procedures according to the current US guidelines.4 They found that the cumulative exposure was as high or higher in many dental procedures for which prophylaxis is not recommended than for those for which prophylaxis is recommended. This was especially so for rubber dam placement.
The cumulative exposure was the product of the intensity of bacteraemia by the proportion of positive blood cultures by the length of bacteraemia by …