Despite the controversy about the risk of individuals developing
bacterial endocarditis of oral origin, numerous Expert Committees in different countries continue to publish prophylactic regimens for the prevention of
bacterial endocarditis secondary to dental procedures. In this paper, we analyze the efficacy of
antibiotic prophylaxis in the prevention of
bacteremia following dental manipulations and in the prevention of
bacterial endocarditis (in both animal models and human studies).
Antibiotic prophylaxis guidelines remain consensus-based, and there is scientific evidence of the efficacy of
amoxicillin in the prevention of
bacteremia following dental procedures, although the results reported do not confirm the efficacy of other recommended
antibiotics. The majority of studies on experimental models of
bacterial endocarditis have verified the efficacy of
antibiotics administered after the induction of
bacteremia, confirming the efficacy of
antibiotic prophylaxis in later stages in the development of
bacterial endocarditis. There is no scientific evidence that prophylaxis with
penicillin is effective in reducing
bacterial endocarditis secondary to dental procedures in patients considered to be "at risk". It has been suggested that there is a high risk of severe
allergic reactions secondary to prophylactically administered
penicillins, but, in reality, very few cases have been reported in the literature. It has been demonstrated that
antibiotic prophylaxis could contribute to the development of bacterial resistance, but only after the administration of several consecutive doses. Future research on
bacterial endocarditis prophylactic protocols should involve the re-evaluation of the time and route of administration of
antibiotic prophylaxis, and a search for alternative antimicrobials.