AHA guidelines for the prevention of endocarditis

The American Heart Association guidelines for the prevention of endocarditis (2007) [1] had the following key points:

  • We concluded that bacteremia resulting from daily activities is much more likely to cause IE than bacteremia associated with a dental procedure.
  • We concluded that only an extremely small number of cases of IE might be prevented by antibiotic prophylaxis even if prophylaxis is 100% effective.
  • Antibiotic prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of IE.
  • Limited recommendations for IE prophylaxis only to those conditions listed below:
    • Prosthetic cardiac valve or prosthetic material used for cardiac valve repair
    • Previous IE
    • Congenital heart disease (CHD)
      • Unrepaired cyanotic CHD, including palliative shunts and conduits
      • Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure
      • Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
    • Cardiac transplantation recipients who develop cardiac valvulopathy
  • Antibiotic prophylaxis is no longer recommended for any other form of CHD, except for the conditions listed above.
  • Antibiotic prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissues or periapical region of teeth or perforation of oral mucosa only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE (those listed above).
  • Antibiotic prophylaxis is reasonable for procedures on 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 (listed above).
  • Antibiotic prophylaxis solely to prevent IE is not recommended for GU or GI tract procedures.
  • Although these guidelines recommend changes in indications for IE prophylaxis with regard to selected dental procedures, the writing group reaffirms that those medical procedures listed as not requiring IE prophylaxis in the 1997 statement remain unchanged and extends this view to vaginal delivery, hysterectomy, and tattooing. Additionally, the committee advises against body piercing for patients with conditions listed above because of the possibility of bacteremia, while recognizing that there are minimal published data regarding the risk of bacteremia or endocarditis associated with body piercing.