Bacterial Endocarditis Prevention Recommendations

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Subject: Bacterial Endocarditis Prevention Recommendations

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Introduction

Infectious endocarditis (IE) is a relatively uncommon, life-threatening disease that may result in substantial morbidity and mortality. Endocarditis usually develops in individuals with underlying structural cardiac defects (Table C-1) who develop bacteremia. Although bacteremia is common after many invasive procedures, only certain bacteria commonly cause endocarditis, and most cases of endocarditis are not attributable to an invasive procedure. 
In 2007, the American Heart Association (AHA) published new guidelines for IE prevention that were unique because for the first time they were evidence-based. The new recommendations no longer recommend IE prophylaxis based solely on an increased lifetime risk of acquisition of IE. They noted that IE is much more likely to result from frequent exposure to random bacteremias associated with daily activities than from bacteremia caused by dental, gastrointestinal (GI) tract, or genitourinary (GU) tract procedures. 
In patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE (Table C-1), IE prophylaxis for dental procedures may be reasonable, even though its actual effectiveness is unknown. Maintenance of optimal oral health and hygiene may reduce the incidence of bacteremia from daily activities and is probably more important than prophylactic antibiotics for a dental procedure to reduce the risk of IE. Antibiotic prophylaxis (Table C-2) is recommended for patients with the conditions listed in Table C-1 who undergo any dental procedure that involves the gingival tissues or periapical region of a tooth and for those procedures that perforate the oral mucosa. Dental procedures in which IE prophylaxis is not recommended are listed in Table C-3
 
TABLE C-1.
Cardiac Conditions Associated with the Highest Risk of Adverse Outcome from Endocarditis for which Prophylaxis with Dental Procedures Is Recommended
 
TABLE C-2.
Infectious Endocarditis Prevention Antibiotic Regimens for Dental Procedures
Antibiotic prophylaxis is no longer recommended for any other form of congenital heart disease (CHD), except for the conditions listed in Table C-1. Antibiotic prophylaxis is recommended for procedures on the 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 (Table C-1). Antibiotic prophylaxis solely to prevent IE is not recommended for GU or GI tract procedures. 
 
TABLE C-3.
Dental Procedures for which Endocarditis Prophylaxis Is Not Recommended
 
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