# Prophylactic Antibiotics for Prevention of Infective Endocarditis or Bacteremia in Pediatric Patients With Congenital Heart Disease Undergoing Dental Procedures: Systematic Review

## TL;DR

This review examines whether antibiotics before dental procedures prevent infections in children with heart defects, finding limited evidence for their effectiveness.

## Contribution

The study provides a systematic review of antibiotic prophylaxis in pediatric congenital heart disease patients undergoing dental procedures.

## Key findings

- Prophylactic antibiotics may increase the odds of infective endocarditis, though not significantly.
- Antibiotics effectively reduced bacteremia after dental procedures in pooled results.
- Evidence certainty is very low due to insufficient and heterogeneous studies.

## Abstract

To assess the effectiveness of prophylactic antibiotics in preventing infective endocarditis (IE) after dental procedures in pediatric patients with congenital heart disease.

Six electronic databases and grey literature were searched for randomized controlled trials (RCTs), case‐control studies, and cohort studies in pediatric patients who received antibiotic prophylaxis (AP) before any dental procedure compared to pediatric patients undergoing the same procedures without AP to prevent IE and/or bacteremia. The Newcastle–Ottawa scale was used to evaluate the internal validity of the included studies. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of evidence.

1774 studies were screened after duplicate removal. Three case‐control studies met the inclusion criteria and were included. One study evaluated IE as an outcome, whereas the other two studies evaluated bacteremia after dental procedures. Meta‐analysis could not be conducted for IE, whereas pooling results were attempted for two studies evaluating bacteremia as an outcome. The odds of IE after a dental procedure within the last 6 months with AP were higher than without AP (Odds ratio: 3.44, 95% CI: 0.93, 12.65, p = 0.06) in the only study. However, AP was effectively able to reduce bacteremia after dental procedures in two studies that evaluated bacteremia (Pooled odds ratio: 0.24, 95% CI: 0.14, 0.42, p < 0.05).

The GRADE evidence was very low to conclude that prophylactic antibiotics might have a role in preventing IE or bacteremia in children with congenital cardiac diseases due to insufficient studies.