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Antibiotic prophylaxis for dental procedures if hydrocephalus shunts

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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
  • 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:


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