Antibiotic prophylaxis for infective endocarditis
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Despite advances in diagnosis and treatment, infective endocarditis remains a dangerous disease, particularly for people at risk because of a prosthetic valve, congenital heart disease, or a history of infective endocarditis, in whom morbidity and mortality approach 50%. 1 Prendergast BD The changing face of infective endocarditis. Heart. 2006; 92: 879-885 Crossref PubMed Scopus (216) Google Scholar Antibiotic prophylaxis for such patients at the time of invasive procedures has been a tenet of cardiac and dental practice for half a century, although the evidence of benefit is limited. Few cases of infective endocarditis are now secondary to oral streptococci, and Staphylococcus aureus (frequently acquired as a result of nosocomial infection or misuse of intravenous drugs) is now the most common pathogen, with attendant higher mortality. 2 Moreillon P Que Y-A Infective endocarditis. Lancet. 2004; 363: 139-149 Summary Full Text Full Text PDF PubMed Scopus (830) Google ScholarKeywords:
Infective Endocarditis
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.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.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.
Infective Endocarditis
Bacteremia
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Infective Endocarditis
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Odds
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Patient with congenital heart disease are susceptible to infective endocarditis, and bacteremia following dental procedures may lead to infective endocarditis is these patients. Therefore prophylactic antibiotics are recommended for patients with congenital heart disease who are undergoing dental procedures that are associated with infective endocarditis. In 1997 American Heart Association revised guidelines for a prophylaxis against infective endocarditis. The new American Heart Association recommendations for the prevention of infective endocarditis represent a substantial departure from past guidelines. Major change involve the indications for prophylaxis, antibiotic choice and dosing that may reduce bacteremic risk. Previously, antibiotic prophylaxis was suggested for dental procedures associated with any amount of bleeding. Now only those that are associated with significant bleeding are recommended for prophylaxis as dictated by clinical judgement. Recommended antibiotic prophylaxis regimens now consist of a single preprocedural dose, no second dose is recommended. This report presents three cases of dental treatment of patients with congenital heart disease under the most recent American Heart Association recommendations for antibiotic prophylaxis.
Infective Endocarditis
Bacteremia
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Two cases of infective endocarditis are reported. In both, vegetations on the cardiac valves characteristic of endocarditis were documented by echocardiography and confirmed at surgery in one of them. The various features of vegetative endocarditis on the echocardiogram are described. Differentiation of these echoes from those produced by other morbid states is discussed. Echocardiography is considered a useful non-invasive technique in the diagnosis of infective endocarditis. Cardiac surgery is usually found to be necessary in addition to medical therapy, when echoes characteristic of vegetative endocarditis are recorded by echocardiography.
Infective Endocarditis
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The Swiss societies of Infectious Diseases, Pediatric Cardiology and Cardiology and the Pediatric Infectious Disease Group of Switzerland present the current update on infective endocarditis prophylaxis in a joint initiative. The major focus of the revised recommendations is a comprehensive prevention campaign for all patients at risk for infective endocarditis. Antibiotic prophylaxis is recommended only for individuals at high risk. Within this high-risk group there is a ranking order, and the conditions are presented accordingly. Antibiotic prophylaxis is no longer recommended for patients with unrepaired ventricular septal defects and patent ductus arteriosus. Recommendations for antibiotic prophylaxis for the prevention of infective endocarditis are categorized in dental and non-dental interventions.
Infective Endocarditis
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Review question / Objective: The aim of the present systematic review and meta-analysis is to determine whether there is a genuine clinical need for Antibiotic Prophylaxis(AP) for the prevention of Infective Endocarditis(IE) in high-risk individuals (particularly those with demonstrable structural heart diseases or valve surgery) undergoing invasive dental procedures. Information sources: PubMed, Science Direct, British Dental Journal and Cochrane Register of Controlled Trials. Search terms used included various combinations of the following subject headings and title or abstract keywords – prophylactic antibiotics, antibiotic prophylaxis, antimicrobial, dentist, extraction, implant, infective endocarditis, or bacterial endocarditis.
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Dentists routinely treat patients who require antibiotic prophylaxis for infective endocarditis. In this article, the signs and symptoms of infective endocarditis as well as the hemodynamic events involved are discussed. Furthermore the rationale for the choice of antibiotic, the type of patient requiring prophylaxis, and the different regimes as recommended by the American Heart Association are presented.
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Infective Endocarditis
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Antibiotic prophylaxis is logical but it is impossible to prove its efficacy. Most cases of infective endocarditis follow seemingly ‘spontaneous’ bacteraemias and cases of seemingly ‘failed’ prophylaxis may have done the same, the prophylaxis having been ‘successful’ for the occasion for which it was given. We cannot find out how many cases of infective endocarditis would have occurred but for successful prophylaxis.
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Secondary prophylaxis
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Infective Endocarditis
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