A Welshman who survived two bouts of endocarditis after having a tooth pulled out – without prior antibiotic treatment – is calling for changes to NICE guidance.
Greg Hutton (62) twice survived the serious and often fatal heart infection that kills almost 30% of sufferers within a year, reports The Independent.
The infection was brought on after he had a tooth removed without being given pre-emptive antibiotics, despite having a heart condition.
He first contracted endocarditis after an extraction in November 2017, when his dentist refused to give him pre-operation antibiotics. The dentist said he was following the National Institute for Health and Care Excellence (NICE) guidelines.
Hutton believes had he been given antibiotics beforehand, he probably would have avoided infection and a subsequent heart attack.
A NICE spokesman said they have updated their guidance this year, but Hutton believes it does not go far enough.
He was born with a bicuspid valve, a congenital heart defect where the aortic valve has two flaps instead of the normal three, for which he had a replacement in 2014.
“In 2017, I had a problem with a filling, and when I saw the dentist he said he would have to pull out the tooth.
“On the day of the appointment, he said he couldn’t give me antibiotics because it goes against the NICE guidelines, and he would get into trouble.
“I would be considered a high-risk patient anywhere else in the world because of my heart valve operation, but in 2008 NICE changed the guidelines because there had been a scare about too many antibiotics prescribed.”
Two weeks after the extraction, Hutton started to feel ill and could barely walk. Doctors initially could not work out what was wrong with him and he had around 35 appointments to identify the issue.
“My GP thought it was leukaemia at one point, but nothing was showing in the blood test,” he said.
“My organs were failing …breaking down slowly, kidney problems, liver problems, I was struggling to breathe.”
Only when Hutton began searching for the cause of his enlarged spleen did he discover a tooth extraction can sometimes cause endocarditis.
He was admitted to hospital where he remained for four months. The only treatment that would stop the infection was gentamicin, which deafened him in one ear: he also suffered an embolism in his spleen.
A few months into his recovery, he became ill again, and was re-admitted to hospital for another three months.
He was treated for fungal endocarditis, which can be more deadly than the bacterial infection he had suffered previously.
“According to statistics I should be dead, but I put that down to my fitness,” said the keen sportsman.
Three months later he was discharged with the words, “go home, enjoy the rest of your life, or however long that may be”.
A couple of months later, he had a heart attack.
After being discharged, Hutton contacted Wolferstans Solicitors, who got him a substantial settlement from his dentist, which he believes to be the second largest on record.
He has now written to NICE urging them to change their guidelines.
Holly Bowditch of Wolferstans Solicitors said: “Since the guidelines were changed in 2008, advising against the prescription of antibiotics before an invasive dental procedure, around 6 700 people have contracted endocarditis when it could have been avoided.
“It is estimated that around 2 000 preventable deaths have occurred.”
She described the current guidance as “ambiguous” and said clarity was long overdue.
A NICE spokesman said they had published an update to their guidance in October and while advice remains that antibiotics should not be prescribed routinely to prevent infective endocarditis (IE) it “may be appropriate” for certain people with structural heart defects.
See more from MedicalBrief archives:
Dentistry: No endocarditis increase with end to antibiotic prophylaxis – Karolinska Institutet
Antibiotics prescribed for dental patients unnecessary 81% of the time
GPs exceed antibiotic duration guidelines for most infections