New Guidelines For Antibiotic Prophylaxis

Why Don't I Need Antibiotics Anymore?

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The American Heart Association’s Endocarditis Committee together with national and international experts on BE extensively reviewed published studies in order to determine whether dental, gastrointestinal (GI), or genitourinary (GU) tract procedures are possible causes of BE. These experts determined that there is no conclusive evidence that links dental, GI, or GU tract procedures with the development of BE.

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The current practice of giving patients antibiotics prior to a dental procedure is no longer recommended EXCEPT for patients with the highest risk of adverse outcomes resulting from BE (see below on this card). The Committee cannot exclude the possibility that an exceedingly small number of cases, if any, of BE may be prevented by antibiotic prophylaxis prior to a dental procedure. If such benefit from prophylaxis exists, it should be reserved ONLY for those patients listed below. The Committee recognizes the importance of good oral and dental health and regular visits to the dentist for patients at risk of BE.

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The Committee no longer recommends administering antibiotics solely to prevent BE in patients who undergo a GI or GU tract procedure.

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Changes in these guidelines do not change the fact that your cardiac condition puts you at increased risk for developing endocarditis. If you develop signs or symptoms of endocarditis – such as unexplained fever – see your doctor right away.  If blood cultures are necessary (to determine if endocarditis is present), it is important for your doctor to obtain these cultures and other relevant tests BEFORE antibiotics are started.

Antibiotic prophylaxis with dental procedures is recommended only for patients with cardiac conditions associated with the highest risk of adverse outcomes from endocarditis, including: 

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• Prosthetic cardiac valve

• Previous endocarditis

• Congenital heart disease only in the following categories:

             – Unrepaired cyanotic congenital heart disease, including those with palliative shunts and conduits

             – Completely repaired congenital heart disease with prosthetic material or device, whether placed by

                surgery or catheter intervention, during the first six months after the procedure*

             – Repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic

                patch or prosthetic device (which inhibit endothelialization)

• Cardiac transplantation recipients with cardiac valvular disease

 

*Prophylaxis is recommended because endothelialization of prosthetic material occurs within six months after the procedure.