Turkiye Klinikleri Journal of Dental Sciences

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Diş Hekimliğinde Dünden Bugüne Antibiyotik Profilaksisi (Amerikan Kalp Derneğinin Önerileri): Sistematik Derleme
Antibiotic Prophylaxy in Dentistry From Past to Present (Recommendations of the American Heart Association): Systematic Review
Adalet ÇELEBİa , Ayşe ÖZCAN KÜÇÜKa , Fethi ATILa
aMersin Üniversitesi Diş Hekimliği Fakültesi, Ağız-Diş ve Çene Cerrahisi ABD, Mersin, Türkiye
Turkiye Klinikleri J Dental Sci. 2024;30(2):312-21
doi: 10.5336/dentalsci.2023-99169
Article Language: TR
Full Text
ÖZET
 Enfektif endokardit (EE), kalp kapakçıklarının veya endokardiyumun, çoğunlukla doğuştan veya kazanılmış kalp kusurlarıyla ilişkili, nadir görülen ancak yaşamı tehdit eden bir mikrobiyal enfeksiyondur. Normal ağız florasında bulunan oral streptokokların, EE vakalarının %10-30'unu oluşturduğu bilinmektedir. Kötü ağız hijyeni, periodontal hastalıklar, dental prosedürler veya normal günlük aktiviteler (örneğin diş fırçalama) sırasında ortaya çıkan geçici bakteriyeminin, bazı EE vakalarının gelişiminin öncüsü olduğu düşünülmektedir. Antibiyotikler odontojenik ve nonodontojenik enfeksiyonların tedavisi dışında lokal ve fokal enfeksiyonlar için profilaksi durumlarında kullanılmaktadır. Amerikan Kalp Derneği geçmişten günümüze belli yıllarda diş hekimliği tedavi prosedürleri sırasında profilaksi ile ilgili tavsiyelerini kılavuzlar yayımlayarak güncellemektedir. 1950'lerden bu yana dental tedaviyi takiben endokarditin önlenmesinde antibiyotik kullanımında kademeli bir azalma olmuştur. 2007'den bu yana tüm güncellenen rehberlerde ağız bakımının dental prosedürlerde uygulanan antibiyotik profilaksisiden (AP) daha etkili olduğu görülmektedir. Bu kılavuzlardan en sonuncusu 2021 yılında radikal değişikliklerle güncellenmiştir. En radikal değişiklik, penisilin alerjisi olan hastalara klindamisin yerine doksisiklin yazılması olmuştur. Bu rehberde de ağız hijyeninin önemi yine vurgulanmıştır. 2021 rehberinde de dental işlemlerde oldukça az miktarda hastaya profilaksi önerilmektedir. Bu makalenin amacı, 1997 yılından 2021 yılına kadar geçen zamanda EE'yi önlemek için uygulanan AP'de meydana gelen değişiklikleri bir arada sunmak ve EE ile ilgili diş hekimlerinin genel bilgilerini tazelemektir.

Anahtar Kelimeler: Antibiyotik profilaksisi; enfektif endokardit; diş hekimliği
ABSTRACT
 Infective endocarditis (IE) is a rare but life-threatening microbial infection of the heart valves or endocardium, most often associated with congenital or acquired heart defects. Oral streptococci in the normal oral flora are known to constitute 10-30% of IE cases. Transient bacteremia that occurs during poor oral hygiene, periodontal disease, dental procedures or normal daily activities (e.g. tooth brushing) is thought to be a precursor to the development of some cases of IE. Antibiotics are used in prophylaxis for local and focal infections, apart from the treatment of odontogenic and non-odontogenic infections. The American Heart Association has been updating its recommendations on prophylaxis during dental treatment procedures by publishing guidelines in certain years from past to present. Since the 1950s there has been a gradual reduction in the use of antibiotics for the prevention of endocarditis following dental treatment. In all updated guidelines since 2007, oral care seems to be more effective than antibiotic prophylaxis (AP) applied in dental procedures. The last of these guidelines was updated in 2021 with radical changes. The most radical change was the prescribing of doxycycline for patients with penicillin allergy instead of clindamycin. The importance of oral hygiene is also emphasized in this guide. In the 2021 guide, prophylaxis is recommended for a very small number of patients in dental procedures. The aim of this article is to present together the changes in AP applied to prevent IE from 1997 to 2021 and to refresh the general knowledge of dentists about IE.

Keywords: Antibiotic prophylaxis; infective endocarditis; dentistry
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