Endocarditis New Guidelines

Infective endocarditis is a serious condition caused by an infection on a valve of the heart. The cause of the infection is presumed to be related to systemic seeding of the blood by bacteria that usually are present in the body on the teeth, skin or gastrointestinal tract. Since 1955, it has been a steadfast recommendation that patients with a history of heart valve disease of almost any type take antibiotics before certain procedures to reduce the chance of endocarditis. This has resulted in millions of patients taking antibiotics before teeth cleaning, colonoscopy or broncoscopy because of a history of a murmur in a cardiac exam.
Recently the American College of Cardiology reviewed the data and made a major change in the recommendations for the prevention of infective endocarditis. The new recommendations take into account the fact that routine use of antibiotics may result in the development of bacterial resistance, making it difficult to treat real infections in the future. Furthermore, the evidence now shows that it is extremely rare to develop endocarditis in the vast majority of patients undergoing any procedure involving the oral mucosa and gastrointestinal and urinary tracts. In fact, the amount of bacteria exposed to the blood during dental work is considered to be so trivial that the risk of endocarditis is no different at the dentist than it is at home brushing your teeth. It is also not recommended to give antibiotics for gastrointestinal or genitourinary procedures, even in patients with a history of valve replacement.
This new recommendation has caused a great deal of stress for many patients who have grown accustomed to antibiotics for dental work. There are still certain groups that benefit from antibiotics with dental work. Patients with a previous history of endocarditis should continue to take antibiotics. Other high-risk patients include those with surgically repaired or implanted valves and patients with complex cyanotic heart disease. Patients with implanted septal occluder devices require antibiotic prophylactically in the first 6 months after placement. Cardiac transplant patients with a history of valve disease should receive antibiotics for dental procedures since they are at high risk for endocarditis because of the medications required to suppress rejection of the transplanted organ.
It is considered appropriate to give antibiotics to the high-risk groups described above. In all other patients, at this time the adverse effects of antibiotics outweigh any potential advantages and are not necessary.