Antibiotic Prophylaxis for Prevention of Infective Endocarditis
Summary of major changes in updated document
- We concluded that bacteremia resulting from daily activities is much more likely to cause infective endocarditis (IE) than bacteremia associated with a dental procedure.
- We concluded that only an extremely small number of cases of IE might be prevented by antibiotic prophylaxis even if prophylaxis is 100 percent effective.
- Antibiotic prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of IE.
- Limit recommendations for IE prophylaxis only to those conditions listed in Box 3.
- Antibiotic prophylaxis is no longer recommended for any other form of congenital heart disease, except for the conditions listed in Box 3.
- Antibiotic prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissues or periapical region of teeth or perforation of oral mucosa only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE (Box 3).
- Antibiotic prophylaxis is reasonable for procedures on respiratory tract or infected skin, skin structures or musculoskeletal tissue only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE (Box 3).
- Antibiotic prophylaxis solely to prevent IE is not recommended for gastrointestinal or genitourinary tract procedures.
- Although these guidelines recommend changes in indications for IE prophylaxis with regard to selected dental procedures (see text), the writing group reaffirms that those medical procedures listed as not requiring IE prophylaxis in the 1997 statement remain unchanged and extends this view to vaginal delivery, hysterectomy, and tattooing. Additionally, the writing group advises against body piercing for patients with conditions listed in Box 3 because of the possibility of bacteremia, while recognizing that there are minimal published data regarding the risk of bacteremia or endocarditis associated with body piercing.
Recommendation Grading
Overview
Title
Antibiotic Prophylaxis for Prevention of Infective Endocarditis
Authoring Organizations
Publication Month/Year
December 31, 2007
Last Updated Month/Year
July 26, 2023
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective endocarditis, which were last published in 1997.
Target Patient Population
Patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infectious endocarditis
Inclusion Criteria
Female, Male, Adolescent, Adult, Child, Older adult
Health Care Settings
Ambulatory, Outpatient
Intended Users
Dentist, nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Prevention
Diseases/Conditions (MeSH)
D019072 - Antibiotic Prophylaxis, D011315 - Preventive Medicine, D004696 - Endocarditis, D004697 - Endocarditis, Bacterial, D011313 - Preventive Dentistry
Keywords
infectious, antibiotic, endocarditis, Antibiotic prophylaxis