From the Guidelines
Infective endocarditis prophylaxis is only recommended for high-risk patients undergoing dental procedures that involve manipulation of either gingival tissue or the periapical region of teeth or perforation of oral mucosa.
High-Risk Conditions
- Patients with a prosthetic heart valve or prosthetic material used for valve repair
- Patients with a past history of infective endocarditis
- Patients with cardiac valvulopathy after cardiac transplantation
- Specific patients with congenital heart disease (CHD)
Prophylaxis Recommendations
- Amoxicillin 2g orally 1 hour before the procedure is the recommended prophylaxis for patients who require it 1
- Prophylaxis is no longer recommended for prevention of endocarditis for procedures that involve the respiratory tract unless the procedure is performed in a high-risk patient and involves incision of the respiratory tract mucosa, such as tonsillectomy and adenoidectomy 1
- Prophylaxis is no longer recommended for prevention of infective endocarditis for GI or GU procedures, including diagnostic esophagogastroduodenoscopy or colonoscopy 1
Rationale for Revisions
- Infective endocarditis is more likely to result from frequent exposure to random bacteremias associated with daily activities than from bacteremia caused by a dental, GI tract, or GU procedure 1
- The risk of antibiotic-associated adverse effects exceeds the benefit (if any) from prophylactic antibiotic therapy 1
- Maintenance of optimal oral health and hygiene may reduce the incidence of bacteremia from daily activities and is more important than prophylactic antibiotics for a dental procedure to reduce the risk of infective endocarditis 1 The current recommendations result in greater clarity for patients, health care providers, and consulting professionals 1.
From the Research
Latest Guidelines for Prevention of Infective Endocarditis
The latest guidelines for the prevention of infective endocarditis recommend the following:
- Antibiotic prophylaxis should only be recommended for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis 2, 3, 4.
- Prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa 2, 3.
- Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure 2.
- The European Society of Cardiology guidelines recommend an individualized indication for antibiotic prophylaxis in patients with intermediary risk, such as those with bicuspid aortic valve and degenerative or rheumatic native valve disease, undergoing orodental interventions 5.
High-Risk Conditions
The guidelines identify the following conditions as high-risk for infective endocarditis:
Recommendations for Dental Procedures
The guidelines recommend the following for dental procedures:
- Antibiotic prophylaxis is recommended for dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa 2, 3.
- Dentists should provide patients with information on the risks posed by invasive dental procedures and how this can be minimized 6.
Non-Dental Interventions
The guidelines recommend the following for non-dental interventions:
- Antibiotic prophylaxis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure 2.