Quality appraisal of antibiotic prophylaxis guidelines to prevent infective endocarditis following dental procedures: a systematic review

Objective. To assess the quality of clinical practice guidelines (CPGs) for the use of antimicrobial prophylaxis to prevent infective endocarditis in indicated dental procedures. Study Design. We searched on Medline/OVID, CINAHL/EBSCO, and EMBASE from January 2011 to January 2022. We included de novo guidelines and excluded adapted or adopted guidelines, and guidelines published before 2011. The guidelines were independently appraised by 4 reviewers using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) Instrument. Results. Four eligible CPGs were appraised: the European Society of Cardiology, the American Heart Association, the National Institute of Health and Care Excellence (NICE), and the Japanese Circulation Society (JCS). Their AGREE II first overall assessments (OA1) were 63%, 58%, 92%, and 71%, respectively. Both NICE and JCS scored the highest in OA1 (>70%), Domain 3 Rigor of Development (85%, 65%), and Domain 5 Applicability (76%, 48%), respectively. The second overall assessment (OA2) of using the CPGs in daily practice was not significantly variable (recommended for use with modifications). Conclusion. Three out of 4 CPGs support that the benefits of prevention of infective endocarditis outweigh the risks of antibiotic resistance.

Automated summary

This study assessed the quality of clinical practice guidelines for the use of antimicrobial prophylaxis in preventing infective endocarditis. The results showed that out of the four eligible guidelines, three supported the benefits of prevention outweighing the risks of antibiotic resistance.