Loyola-Rodriguez Juan Pablo, Franco-Miranda Alexandre, Loyola-Leyva Alejandra, Perez-Elizalde Bulfrano, Contreras-Palma Guillermo, Sanchez-Adame Oscar
Laboratorio de Biomateriales y Bionanotecnología, Maestría en Ciencias de la Salud, Facultad de Medicina, Universidad Autónoma de Guerrero, Acapulco, México.
Special Care Dentistry, Catholic University of Brasilia, Faculty of Dentistry, Brasilia, Brasil.
Spec Care Dentist. 2019 Nov;39(6):603-609. doi: 10.1111/scd.12415. Epub 2019 Aug 28.
The purpose of this statement is to debate the recommendations of the American Heart Association (AHA) for the prevention of infective endocarditis through an antibiotic prophylaxis protocol and its relation with bacterial resistance to antibiotics. Since dental infections involve biofilms that include several bacterial species (Gram-negative and Gram-positive), it is essential, from the dental point of view, to consider the frequency, magnitude, and duration of bacteremia associated with active dental infections before applying antibiotic prophylaxis. The actual guidelines for antibiotic prophylaxis should be revised according to recent evidence of bacterial resistance. Amoxicillin/clavulanic acid and moxifloxacin should be considered due to their effectiveness against bacteria associated with oral, GU, and GI infections and the low rates of antibiotic resistance associated with these antibiotics, instead of the actual protocol, which includes amoxicillin (2 g) or clindamycin (600 mg) administered an hour before the dental procedures. The breaking point to test the antibiotic bacterial resistance (ABR) had a wide range in the different studies that were analyzed, which could explain the widely varied ABR percentages reported for the various antibiotics used for antibiotic prophylaxis.
本声明的目的是就美国心脏协会（AHA）通过抗生素预防方案预防感染性心内膜炎的建议及其与细菌对抗生素耐药性的关系展开辩论。由于牙科感染涉及包含多种细菌种类（革兰氏阴性菌和革兰氏阳性菌）的生物膜，从牙科角度来看，在应用抗生素预防之前，必须考虑与活动性牙科感染相关的菌血症的频率、程度和持续时间。抗生素预防的实际指南应根据细菌耐药性的最新证据进行修订。应考虑使用阿莫西林/克拉维酸和莫西沙星，因为它们对与口腔、泌尿生殖道和胃肠道感染相关的细菌有效，且与这些抗生素相关的抗生素耐药率较低，而不是目前的方案，即包括在牙科手术前一小时服用阿莫西林（2克）或克林霉素（600毫克）。在分析的不同研究中，测试抗生素细菌耐药性（ABR）的断点范围很广，这可以解释所报道的用于抗生素预防的各种抗生素的ABR百分比差异很大的原因。
