Infective Endocarditis

Infective Endocarditis

New guidelines for prevention of infective endocarditis were released by the American Heart Association April 19. The AHA and ADA now recommend that fewer dental patients with heart disease receive antibiotic prophylaxis before dental procedures to prevent the heart infection called infective endocarditis (IE). The guidelines were developed by a group appointed by the AHA that included experts in infectious disease and cardiology and members representing the ADA. The guidelines were endorsed by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society.

After reviewing relevant scientific literature from 1950–2006, the group concluded that bacteremia resulting from daily activities is much more likely to cause IE than bacteremia associated with a dental procedure. In addition, only an extremely small number of IE cases might be prevented by antibiotic prophylaxis, even if prophylaxis is 100% effective. Based on these conclusions, antibiotic prophylaxis is now recommended before dental procedures only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE, such as patients with artificial heart valves, a history of endocarditis, certain serious congenital heart conditions and heart transplant patients who develop a problem with a heart valve.

The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with:

* mitral valve prolapse
* rheumatic heart disease
* bicuspid valve disease
* calcified aortic stenosis
* congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

For more details see ADA.org.

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