Antibiotic prophylaxis for dental procedures if hydrocephalus shunts

Antibiotic prophylaxis for dental procedures if hydrocephalus shunts

• antibiotic prophylaxis is not routinely required for individuals with shunts for hydrocephalus
• occurrence of shunt infections has not been linked with dental procedures and the theoretical risk appears negligible
• is no specific UK guidance relating to shunts and a need for antibiotic prophylaxis

Non-routine management

• to determine individual instances where prophylaxis may be warranted, consider:
  • the nature of the dental treatment and risk of transient bacteraemia, and
  • type of shunt and risk of bacteraemia-induced shunt infection
  • the type of shunt should be confirmed with the individual or GP. Seek clarification from their neurologist if necessary

Consider whether dental treatment is invasive or non-invasive

• dental procedures can be invasive (e.g. abscess draining, tooth extractions or implant placement) or non-invasive (e.g. supra-gingival scale and polish, removal of sutures or radiographs)
• invasive treatment
  • invasive procedures can cause transient bacteraemia
    • however, the magnitude and frequency of this bacteraemia is less than that caused during normal oral function (e.g. tooth brushing, dental flossing and chewing)
    • antibiotic prophylaxis is not considered necessary unless the individual has other clinical risk factors as described by UK antimicrobial prescribing guidance (1)
• non-invasive procedures do not pose the same risk of generating transient bacteraemia making antibiotic prophylaxis unnecessary

Consider the type of shunt

• if a shunt has vascular access, there is a theoretical concern that transient bacteraemia could travel to the shunt and cause infection
  • this risk is considered negligible (1)
  • ventriculoatrial (VA) shunts have vascular access although they are rarely used in the UK
  • prophylactic antibiotics should not be routinely prescribed if a shunt has vascular access (1)
    • however:
      • use your clinical judgement to determine if there is a sufficient need. Consider the individual’s opinion and preference along with their clinical history
      • seek specialist neurology input if required
• if a shunt does not have vascular access, there is no risk from transient bacteraemia
  • ventriculoperitoneal (VP) shunts are the most widely used shunt in the UK
  • prophylactic antibiotics are not required (1)

Reference:

• NHS Specialist Pharmacy Service (April 2022). Assessing if individuals with hydrocephalus shunts require antibiotic prophylaxis for dental procedures