Endocarditis Prophylaxis(EP) in Congenital and Acquired Heart Diseases during Interventions in the Oropharynx: Knowledge in Dentists (Endocarditis Prophylaxis in Intervention in Oropharynx Study, EPIO Study)

Objectives: Endocarditis is a frequent serious illness with still high morbidity and mortality. Dental interventions are one of the main causes of significant bacteremia and lead with an incidence of approx. 1.71 - 2.02, and the Oropharynx surgery of approx. 2.56/100 interventions in risk patients without guidance-appropriate prophylaxis to endocarditis, as a rule within 14 days after the procedure.

Methods: Knowing the problem of the still too frequent ignorance, the lack of acceptance of EP in the field of dentistry was performed within the framework of nationwide training on “Rational antibiotic therapy and -prophylaxis in the dental clinic and practice in interventions in the dental-maxillofacial-area as well as neighboring organ systems ” the information stand with dentists in each case before the seminars standardized by means of questionnaire.

Results: 384 dentists, 240 males, 144 females, age 25–64years old, 23 clinicians, 361 practitioners: ØKnowledge about EP in dental procedures only ~38.6%, min.18.75% and max. 82.82%, ØIgnorance 61.4%. Clinicians no better than practitioners. Knowledge especially hardly in practice in the risk assessment of patients. Hardly any knowledge about the preparation of guideline-dosages in children but also in adults at risk, and in the case of penicillin intolerance. As first-line antibiotic is especially called clindamycin, also by penicillin tolerance; significantly less, only in about ⅓ of cases, penicillin V or aminopenicillin; aminopenicillin, however, according to guidelines is the first-line antibiotic in patients without penicillin allergy. Correct dosage usually only known with clindamycin; at Amoxicillin doses of 10 µg to 10 g/day are called! Almost completely lacking knowledge about doses of antibiotics in childhood. Mostly mixing EP and therapy of dental infections. Approximately two-thirds of all dentists continue the EP in the sense of a therapy over 3–5 days and longer. EP and therapy are equated. - Little knowledge or over-supply if there is no need for EP, as indicated above at PCI, post ACB, PM or ICD implantation. Approximately half of all dentists only collect the general medical history by written questioning, not own self!

Conclusion: The exact data collection of the information level of the dentists about the EP in patients with a risk of ~50% ignorance also underlines the considerable need for elucidation, the need for training in the acceptance of EP, in this medical group.