Pallasch T J
Pharmacology Section, School of Dentistry, University of Southern California, Los Angeles 90089-0641.
Int Dent J. 1989 Sep;39(3):183-96.
To some, antibiotic prophylaxis has reached the level of doctrine: it is highly successful with little attendant harm to the patient. To its skeptics, antibiotic prophylaxis has rarely been proved effective in human clinical studies and possesses little present scientific justification. The truth lies somewhere between the two extremes. The use of antibiotic chemoprophylaxis to prevent infective endocarditis in high-risk patients and other bacteraemia-induced infections in individuals with orthopaedic prostheses, impaired host defences and on haemodialysis is probably justified prior to dental treatment. Yet the issue of risk-benefit needs to be properly addressed. In some situations antibiotic prophylaxis may, potentially, be more harmful to the patient than the infection that might be prevented. With antibiotic prophylaxis there is no certainty that it will work in any specific situation. The general impression that dentist-induced bacteraemias are responsible for the vast majority of infective endocarditis cases is erroneous, for these bacteraemias may cause as little as 4 per cent or less of all infective endocarditis. A minor role for dentist-induced bacteraemias in other infections is also likely.
对于一些人来说，抗生素预防已经达到了教条的程度：它非常成功，对患者几乎没有附带危害。而对于怀疑者来说，抗生素预防在人体临床研究中很少被证明是有效的，目前也几乎没有科学依据。真相介于这两个极端之间。在牙科治疗前，使用抗生素化学预防来预防高危患者的感染性心内膜炎以及骨科假体植入者、宿主防御功能受损者和接受血液透析者的其他菌血症引起的感染可能是合理的。然而，风险效益问题需要得到妥善解决。在某些情况下，抗生素预防对患者的潜在危害可能比可能预防的感染更大。使用抗生素预防并不能确定它在任何特定情况下都能起作用。认为牙医引起的菌血症是绝大多数感染性心内膜炎病例的原因这种普遍看法是错误的，因为这些菌血症在所有感染性心内膜炎中所占比例可能低至4%或更低。牙医引起的菌血症在其他感染中可能也只起次要作用。
