New recommendations for the prevention of infective endocarditis

PURPOSE OF REVIEW: A revision of the American Heart Association guidelines for the prevention of infective endocarditis was recently published in their journal Circulation. Pediatric practitioners as well as other primary care specialists and dentists will need to advise patients as to whether they require antibiotic prophylaxis prior to invasive procedures. Some patients who formerly received prophylaxis for certain procedures may need an explanation when they are told that antibiotic prophylaxis is no longer recommended for them. RECENT FINDINGS: New research casts doubt on whether dental, surgical and invasive diagnostic procedures really are the cause of infective endocarditis. Events of daily life are more likely to cause bacteremia than planned procedures. Neither constant nor intermittent antibiotic prophylaxis has been proven to prevent endocarditis. SUMMARY: The authors of the revised American Heart Association guidelines made significant changes from past guidelines restricting prophylaxis to only those individuals with cardiac conditions that pose the highest risk for bad outcome should infective endocarditis occur and only for dental procedures causing the highest bacteremia rates.