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• #1 Prophylaxis against infective endocarditis: summary of NICE guidance | Heart

  https://heart.bmj.com/content/94/7/930

  Infective endocarditis is a rare condition with an incidence of less than 10 per 100000 population/year. It is, however, associated with a high mortality and morbidity. Accepted clinical practice has been to use antibiotic prophylaxis in those at risk of infective endocarditis undergoing dental and certain non-dental interventional procedures, in the belief that this may prevent its development. The effectiveness of such antibiotic prophylaxis in humans is, however, not proved and the recent American Heart Association guideline recommends a much more limited role for antibiotic prophylaxis against infective endocarditis. This article summarises the most recent guidance from the National Institute for Health and Clinical Excellence (NICE) on antibiotic prophylaxis against infective endocarditis.

• #2 Subacute Bacterial Endocarditis Prophylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532983/

  Infective endocarditis is an infection of the heart’s endocardial surfaces involving one or more heart valves. […] Several risk factors can predispose patients to infective endocarditis, including structural heart disease (such as valvular disease or congenital heart disease), prosthetic heart valves, indwelling cardiovascular device, intravascular catheter, chronic hemodialysis, HIV infection, diabetes, or a prior history of infective endocarditis. […] Managing both types of bacteria necessitates distinct prophylactic approaches to prevent further complications of infective endocarditis. […] With the ongoing increase in the incidence of infective endocarditis in the United States, healthcare professionals face the imperative task of making judicious decisions regarding antibiotic prophylaxis to mitigate further complications.

• #2 Prophylaxis against infective endocarditis: summary of NICE guidance | Heart

  https://heart.bmj.com/content/94/7/930

  In summary, this guideline recommends that antibiotic prophylaxis to prevent infective endocarditis should not be given to adults and children with structural cardiac defects at risk of infective endocarditis undergoing dental and non-dental interventional procedures. The basis for this recommendation is: […] There is no consistent association between having an interventional procedure, dental or non-dental, and the development of infective endocarditis. […] Regular tooth brushing almost certainly presents a greater risk of infective endocarditis than a single dental procedure because of repetitive exposure to bacteraemia with oral flora. […] The clinical effectiveness of antibiotic prophylaxis is not proved. […] Antibiotic prophylaxis against infective endocarditis for dental procedures is not cost effective and may.

• #3 Endocarditis Prophylaxis: An Evolution of Change | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0215/p421.html

  In 1955, the American Heart Association (AHA) started making recommendations for the prevention of infective endocarditis. Since then, patients considered at increased risk of infective endocarditis who were undergoing certain dental procedures or upper respiratory, gastrointestinal (GI), or genitourinary (GU) tract procedures were prescribed antibiotics. […] The most recent guidelines, summarized in this issue of American Family Physician, are the ninth revision of the original recommendations and represent a significant change because the AHA no longer recommends endocarditis prophylaxis for most patients. […] The AHA concluded that infective endocarditis is much more likely to result from frequent exposure to random bacteremia associated with daily activities than from bacteremia caused by a dental or GI or GU tract procedure.

• #3 Endocarditis Prophylaxis: An Evolution of Change | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0215/p421.html

  The AHA also stated that prophylaxis may prevent an exceedingly small number of cases of infective endocarditis (if any) in persons who undergo a dental or GI or GU tract procedure, and that the risk of antibiotic-associated adverse events exceeds the benefit (if any) from antibiotic prophylaxis. […] This includes patients with four cardiac conditions: (1) prosthetic cardiac valve (or prosthetic material used for valve repair); (2) history of endocarditis; (3) certain congenital heart disease; or (4) cardiac valvulopathy in cardiac transplant recipients. […] A major departure from previous guidelines is that administration of antibiotics solely to prevent endocarditis is not recommended for any patients who undergo a GI or GU tract procedure. […] The current guidelines may violate longstanding expectations and practice patterns of health care professionals and patients.

• #4 Endocarditis Prophylaxis, Adults: Endocarditis Prophylaxis, Adults

  https://emedicine.medscape.com/article/2172262-overview

  The American Heart Association (AHA) Guidelines for Prevention of Infective Endocarditis were updated in 2007 and included numerous changes from the previous 1997 version. The guidelines were approved by the Council on Scientific Affairs of the American Dental Association as it relates to dentistry. Additionally, the guideline is endorsed by the Infectious Diseases Society of America. […] Major changes in the updated AHA guidelines include the following: […] IE prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk for adverse outcome from IE. […] For patients with these underlying cardiac conditions, prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. […] Prophylaxis is not recommended based solely on an increased lifetime risk for acquisition of infective endocarditis. […] Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure.

• #4 Endocarditis Prophylaxis, Adults: Endocarditis Prophylaxis, Adults

  https://emedicine.medscape.com/article/2172262-overview

  The antibiotic prophylactic regimens recommended by the AHA are only for patients with underlying cardiac conditions associated with the highest risk for adverse outcome from infective endocarditis. […] Antibiotic prophylaxis is indicated for the following high-risk cardiac conditions: […] For patients with high cardiac risk, antibiotic prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. […] Antibiotics no longer are recommended for endocarditis prophylaxis in patients undergoing genitourinary or gastrointestinal tract procedures, including vaginal or caesarean delivery. […] In 2023, The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC) released their guidelines, which were last updated in 2015. They continued to recommend antibiotic prophylaxis only for patients at the highest risk, which broadened to include patients with previous history of IE, surgical or transcatheter prosthetic valve or valve repair, uncorrected congenital heart disease, and ventricular assist devices.

• #4 Endocarditis Prophylaxis, Adults: Endocarditis Prophylaxis, Adults

  https://emedicine.medscape.com/article/2172262-overview

  The most common cause of endocarditis for dental, oral, respiratory tract, or esophageal procedures is S viridans (alpha-hemolytic streptococci). Antibiotic regimens for endocarditis prophylaxis are directed toward S viridans, and the recommended standard prophylactic regimen is a single dose of oral amoxicillin.

• #5 Endocarditis Prophylaxis, Adults: Endocarditis Prophylaxis, Adults

  https://emedicine.medscape.com/article/2058895-overview

  The American Heart Association (AHA) Guidelines for Prevention of Infective Endocarditis were updated in 2007 and included numerous changes from the previous 1997 version. […] Major changes in the updated AHA guidelines include the following: Only an extremely small number of cases of infective endocarditis (IE) might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100% effective. IE prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk for adverse outcome from IE. For patients with these underlying cardiac conditions, prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. Prophylaxis is not recommended based solely on an increased lifetime risk for acquisition of infective endocarditis. Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure.

• #5 Endocarditis Prophylaxis, Adults: Endocarditis Prophylaxis, Adults

  https://emedicine.medscape.com/article/2058895-overview

  In 2023, The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC) released their guidelines, which were last updated in 2015. They continued to recommend antibiotic prophylaxis only for patients at the highest risk, which broadened to include patients with previous history of IE, surgical or transcatheter prosthetic valve or valve repair, uncorrected congenital heart disease, and ventricular assist devices. […] The most common cause of endocarditis for dental, oral, respiratory tract, or esophageal procedures is S viridans (alpha-hemolytic streptococci). Antibiotic regimens for endocarditis prophylaxis are directed toward S viridans, and the recommended standard prophylactic regimen is a single dose of oral amoxicillin.

• #6 AHA Guideline on Endocarditis Prevention

  https://www.idsociety.org/practice-guideline/endocarditis-prevention/

  The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective endocarditis that were last published in 1997. […] The major changes in the updated recommendations include the following: (1) The Committee concluded that only an extremely small number of cases of infective endocarditis might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100% effective. (2) Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. (3) For patients with these underlying cardiac conditions, prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. (4) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective endocarditis. (5) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure. These changes are intended to define more clearly when infective endocarditis prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations.

• #7 Prevention of endocarditis: Antibiotic prophylaxis and other measures – UpToDate

  https://www.uptodate.com/contents/prevention-of-endocarditis-antibiotic-prophylaxis-and-other-measures

  Prevention of endocarditis: Antibiotic prophylaxis and other measures […] Measures for prevention of infective endocarditis (IE) are discussed here, including the clinical approach and rationale for antibiotic prophylaxis prior to dental procedures. […] Antibiotic prophylaxis prior to invasive dental or invasive oral procedures is warranted only for patients with conditions or implanted devices associated with the highest risk of an adverse outcome if IE occurs. […] Preventive measures to reduce the risk of infective endocarditis (IE) include: Maintenance of oral hygiene. […] Antibiotic prophylaxis prior to surgery reduces the risk of surgical site infection, as discussed separately, which may reduce the risk of subsequent endocarditis. A key example of this approach is antibiotic prophylaxis prior to cardiac surgery. […] For patients with history of IE and successfully closed PDA or VSD should continue to receive antibiotic prophylaxis prior to dental procedures. […] Antibiotic prophylaxis is warranted for patients undergoing certain invasive procedures to reduce the risk of surgical site infection. A key example is implantation of prosthetic heart valves (surgical or transcatheter), prosthetic intravascular material, or prosthetic intracardiac material; this intervention is beneficial for prevention of surgical site infection and might reduce the risk of early prosthetic valve endocarditis, although evidence is limited. […]

• #8 How to achieve infective endocarditis prophylaxis

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/vol16no33

  The most important steps in endocarditis prevention remain educating patients to maintain good oral and cutaneous hygiene, as well as adhering strictly to sterile techniques during invasive procedures in the healthcare setting. […] Providing prophylaxis to individuals at high risk of adverse outcomes undergoing high-risk procedures seems efficient and cost-effective.

• #8 How to achieve infective endocarditis prophylaxis

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/vol16no33

  Although the mortality and morbidity risks of infective endocarditis are well known, the use of antibiotic prophylaxis in prevention has been controversial due to the lack of strong evidence, as well as the potential disadvantages of routine antibiotic prophylaxis (i.e., antibiotic resistance, adverse drug reactions, costs). […] Prophylaxis is generally achieved by administering a single dose of an antibiotic that is expected to cover the potential pathogens 30-60 minutes before such procedures. […] The European Society of Cardiology (ESC) and American Heart Association (AHA) guidelines have each restricted prophylactic antibiotics to those patients with the highest risk of adverse outcomes. […] High-risk individuals to whom antibiotic prophylaxis should be provided are as follows: Patients with prosthetic valves (including transcatheter valves) and patients who have undergone valve repair in whom a prosthetic material is used.

• #9 Infective Endocarditis | American Heart Association

  https://www.heart.org/en/health-topics/infective-endocarditis

  Antibiotic prophylaxis is reasonable before the above-mentioned dental procedures for people with heart conditions who have any of the following: […] Antibiotic prophylaxis may be reasonable for certain medical procedures on the respiratory tract or infected skin, skin structures or musculoskeletal tissue for adults with underlying heart conditions associated with the highest risk of poor outcomes from IE. […] Antibiotic prophylaxis is not recommended solely to prevent IE for adults who have some non-dental procedures, including genitourinary or gastrointestinal tract procedures. […] You can help reduce the risk of IE by maintaining good oral health through regular professional dental care and the use of dental products such as manual, powered and ultrasonic toothbrushes; dental floss; and other plaque-removal devices.

• #9 Infective Endocarditis | American Heart Association

  https://www.heart.org/en/health-topics/infective-endocarditis

  If you meet the requirements for antibiotic prophylaxis for dental treatment or oral surgery, your cardiologist or other health care professional may give you an American Heart Association wallet card (PDF). Show this card to your dentist, pediatrician, family physician or other health care professional. It recommends the type of antibiotic and dose for IE prophylaxis. […] Your health care team can provide you with more information and answer your questions about preventing IE.

• #10 Subacute Bacterial Endocarditis Prophylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532983/

  However, guidelines issued by the American Heart Association (AHA) in 2007 notably curtailed the indications for antibiotic use in endocarditis prophylaxis. […] Preventive measures against infective endocarditis include the following steps: Maintaining optimal oral hygiene. […] Administering antibiotics prophylactically before certain invasive dental or oral procedures. […] The rationale for taking prophylactic antibiotic therapy for subacute bacterial endocarditis includes the following: Due to the fatal nature of infective endocarditis, prevention is preferable to treating established infections. […] Prophylactic antibiotics aim to decrease the incidence of bacteremia associated with invasive dental, oral, gastrointestinal, and genitourinary tract procedures. […] The AHA currently recommends antibiotic prophylaxis for the following patients with certain high-risk cardiac conditions: Patients with prosthetic cardiac valves.

• #10 Subacute Bacterial Endocarditis Prophylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532983/

  Patients with a prior history of infective endocarditis. […] Patients who have undergone cardiac transplantation and have valve regurgitation caused by a structurally abnormal valve. […] Patients with congenital heart disease with: Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits. […] Prophylaxis against infective endocarditis is not recommended in patients at risk of infective endocarditis undergoing non-dental procedures, including transesophageal echocardiogram, esophagogastroduodenoscopy, colonoscopy, or cystoscopy unless there is an active infection present. […] Prophylaxis against subacute bacterial endocarditis demands vigilant monitoring and effective communication among all members of the interprofessional healthcare team.

• #11

  https://www.nhs.uk/conditions/endocarditis/prevention/

  If you have an increased risk of developing endocarditis, it’s important to limit your exposure to any infection that could trigger it. […] If you’re at increased risk of developing endocarditis, it’s important that you practise good oral and dental hygiene. […] Visit your dentist on a regular basis to ensure you maintain good oral health and minimise the risk of bacteria entering your bloodstream through your mouth. […] Regular handwashing will help to prevent bacteria spreading. […] It’s also very important to wash any cuts or grazes carefully as soon as you notice them to prevent them becoming infected. […] Research has found that the benefits of antibiotics in preventing endocarditis are outweighed by the risk they’ll cause serious side effects. […] Antibiotics should only be used when absolutely necessary.

• #12 Prevention of Infective Endocarditis | Doctor

  https://patient.info/doctor/prevention-of-infective-endocarditis

  Routine prophylaxis is now no longer recommended and antibiotics would only be given to treat active infection (of whatever type) whilst awaiting (or with) microbiological advice. […] Any infection in patients at risk of endocarditis should be investigated promptly and treated appropriately to reduce the risk of endocarditis. […] Good oral hygiene is very important and good dental care should be facilitated. […] General measures and health education have enormous potential to prevent IE – for example:

• #13 Prevention of endocarditis: Antibiotic prophylaxis and other measures – UpToDate

  https://www.uptodate.com/contents/prevention-of-endocarditis-antibiotic-prophylaxis-and-other-measures/print

  Prevention of endocarditis: Antibiotic prophylaxis and other measures […] Measures for prevention of infective endocarditis (IE) are discussed here, including the clinical approach and rationale for antibiotic prophylaxis prior to dental procedures. […] The indications for IE prophylaxis in 2021 American Heart Association (AHA) guidelines are narrower than indications outlined in prior (AHA) guidelines. […] Measures for prevention of IE include: Maintenance of oral hygiene. […] Antibiotic prophylaxis prior to invasive dental or invasive oral procedures. […] Timely treatment of infections with pathogens likely to cause endocarditis. […] Antibiotic prophylaxis prior to surgery reduces the risk of surgical site infection, as discussed separately, and has been postulated to reduce the risk of subsequent endocarditis. […] Maintenance of oral hygiene is important to reduce the risk of gingivitis and periodontitis as well as the risk of bacteremia. […] Antibiotic prophylaxis is warranted for patients with cardiac conditions that confer the highest risk of adverse outcome from IE prior to invasive dental or invasive oral procedures. […] Antibiotic prophylaxis prior to invasive dental or invasive oral procedures is warranted only for patients with conditions or implanted devices associated with the highest risk of an adverse outcome if IE occurs. […] The risk of IE is highest for invasive dental or invasive oral procedures that involve manipulation of gingival tissue or the periapical region of the teeth or perforation of the oral mucosa, such as tooth extractions or drainage of a dental abscess. […] Antibiotic prophylaxis regimens for invasive dental or invasive oral procedures target prevention of viridans group streptococcal IE. […] Antibiotic prophylaxis prior to surgery reduces the risk of surgical site infection, as discussed separately, which may reduce the risk of subsequent endocarditis. […] Patients with history of IE with successfully closed PDA or VSD should continue to receive antibiotic prophylaxis prior to dental procedures. […]

• #14 2023 ESC Guidelines for Management of Endocarditis: Key Points

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2023/08/29/20/49/2023-esc-guidelines-for-endocarditis-esc-2023

  The following are key points to remember from the 2023 European Society of Cardiology (ESC) guidelines for the management of endocarditis: […] Prevention […] Populations at high risk of infective endocarditis (IE) include patients with previous IE; patients with a surgically implanted valve, transcatheter valve, or prior valve repair; patients with uncorrected cyanotic congenital heart disease (CHD) or those with CHD and prior repair involving prosthetic material; and patients with a ventricular assist device. […] Prevention should include general hygienic measures including oral hygiene for patients at intermediate or high risk of IE. […] Antibiotic prophylaxis is recommended in patients at high risk of IE undergoing an oral-dental procedure. […] Antibiotic prophylaxis should be considered in patients with prior transcatheter mitral or tricuspid valve repair, and may be considered in heart transplant recipients and among high-risk patients undergoing invasive respiratory, gastrointestinal, genitourinary tract, skin, or musculoskeletal procedures. […] Antibiotic prophylaxis before dental procedures is not warranted to prevent cardiac implanted electronic device (CIED)-associated IE. […] Patient education is recommended for the risk of IE recurrence and for preventative measures with emphasis on dental health.

• #15 Guidelines on prophylaxis to prevent infective endocarditis | British Dental Journal

  https://www.nature.com/articles/sj.bdj.2016.49

  The regime recommended by the ESC is very similar to that of the AHA but differs in two main respects from that previously used in the UK. […] Both the ESC and AHA guidance currently recommend clindamycin antibiotic prophylaxis for those allergic to penicillins. […] Early diagnosis of IE is associated with improved outcomes. […] Patients at increased risk should be advised of the symptoms and signs of IE and the need to see their GP quickly should they occur, particularly if they develop soon after a high-risk dental or other invasive procedure for example, body piercing. […] It can only be hoped that current and future research will better define the role of antibiotic prophylaxis and other measures in reducing the risk of IE.

• #15 Guidelines on prophylaxis to prevent infective endocarditis | British Dental Journal

  https://www.nature.com/articles/sj.bdj.2016.49

  Describes the outcome of two important new guideline reviews with conflicting advice regarding the use of antibiotic prophylaxis to prevent infective endocarditis (IE). […] Provides guidance for dentists who are managing patients at risk of IE in the current climate of conflicting guidance and the new legal requirements on obtaining informed consent. […] Recent evidence that identified an increase in endocarditis incidence prompted a guideline review by NICE and the European Society for Cardiology which produces guidance for the whole of Europe. […] Despite reviewing the same evidence they reached completely opposing conclusions. […] The resulting conflict of opinions and guidance is confusing and poses difficulties for dentists, cardiologists and their patients. […] The current AHA guidelines take a very similar view to the ESC guidelines.

• #16 Antibiotic Prophylaxis of Infective Endocarditis for Dental Procedures

  https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/dental/endocarditis-prophylaxis/

  Endocarditis prophylaxis is only recommended in certain situations, as antibiotic prophylaxis may only be effective at preventing a very small number of endocarditis cases. […] There is evidence demonstrating effectiveness of antibiotic prophylaxis in reducing the incidence of infective endocarditis in specific high-risk patients, which are listed below. […] Maintenance of optimal oral health and hygiene and regular dental review are important in reducing the risk of endocarditis from both daily activities and dental procedures. […] Endocarditis prophylaxis is recommended in patients with any cardiac condition listed below for at-risk dental procedures including: […] Antibiotic prophylaxis is recommended in: Patients with previous infective endocarditis. […] Patients with surgically implanted prosthetic valves and with any material used for surgical cardiac valve repair.

• #16 Antibiotic Prophylaxis of Infective Endocarditis for Dental Procedures

  https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/dental/endocarditis-prophylaxis/

  Patients with transcatheter implanted aortic and pulmonary valvular prostheses. […] Patients with venticular assist devices. […] Patients with untreated cyanotic Congenital Heart Disease (CHD), and patients treated with surgery or transcatheter procedures with post-operative palliative shunts, conduits, or other prostheses. […] After surgical repair, in the absence of residual defects or valve prostheses, antibiotic prophylaxis is recommended only for the first 6 months after the procedure. […] Antibiotic prophylaxis should be considered in patients with transcatheter mitral and tricuspid valve repair. […] Antibiotic prophylaxis may be considered in recipients of heart transplant. […] If the patients cardiac condition is unclear to the treating dentist, advice should be sought from the patients GP or Cardiologist.

• #17 Guidelines for Endocarditis Prevention – Canadian Congenital Heart Alliance

  https://cchaforlife.org/learn-about-chd/guidelines-endocarditis-prevention/

  Prophylaxis indicated: Prosthetic cardiac valves, Previous infective endocarditis, Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits, Completely repaired congenital heart defect with prosthetic material or device, 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 transplant recipients with cardiac valvulopathy. […] It should be noted that with the exception of the conditions listed above, antibiotic prophylaxis is no longer recommended for any other form of CHD. […] In addition to identifying the underlying cardiac conditions that warrant prophylaxis, the Committee addressed the dental procedures for which prophylaxis is warranted if such procedures are performed in high-risk patients. […] The procedures for which prophylaxis is reasonable are as follows: All dental procedures that involve the manipulation of gingival tissue, the periapical region of teeth or the perforation of the oral mucosa.

• #17 Guidelines for Endocarditis Prevention – Canadian Congenital Heart Alliance

  https://cchaforlife.org/learn-about-chd/guidelines-endocarditis-prevention/

  Those living with Congenital Heart Disease may be concerned developing Endocarditis or if they have been told they no longer require antibiotic prophylaxis. […] Prophylaxis prevents an exceedingly small number of cases of IE, if any, in individuals who undergo a dental, GI tract or GU tract procedure. […] The risk of antibiotic-associated adverse events exceeds the benefit, if any, from prophylactic antibiotic therapy except in very high-risk situations. […] Maintenance of optimal oral health and hygiene may reduce the incidence of bacteremia from daily activities and thus the risk of IE, and is more important than the use of prophylactic antibiotics for dental procedures. […] The new guidelines suggest that prophylaxis should be targeted at conditions that are associated with the highest probability of adverse outcomes from IE.

• #18 Endocarditis Prevention | Marfan Trust

  https://www.marfantrust.org/resources/52-endocarditis-prevention

  Endocarditis Prevention Advice ICE Card 10 Jul 2022 Endocarditis, Treatment and Managment […] You are at High Risk if you have: – Previously had infective endocarditis – Had heart valve replacement or repair […] You are at Moderate Risk if you have/have had: – Unoperated heart valve disease (a leaking or narrowed heart valve) […] Advice for Dentists Dental work where antibiotic prophylaxis should be considered in high risk patients includes: Extractions, Subgingival scaling, All procedures that involve manipulation of the gingival tissue or the periapical region of teeth or perforation of the oral mucosa. […] For patients who have a penicillin allergy or who have taken a penicillin or cephalosporin-group antibiotic in the last 4 weeks: Clindamycin 600mg orally (child 50mg/kg up to 3g); orally, 1 hour before the procedure. […] For patients with no allergy to penicillin or ampicillin: amoxicillin or ampicillin 2g 30-60 minutes pre procedure.

• #18 Endocarditis Prevention | Marfan Trust

  https://www.marfantrust.org/resources/52-endocarditis-prevention

  The medical and dental professions now recommend a return to antibiotic prophylaxis in high and moderate risk patients, as above. […] Recommendations to Reduce Risk: Maintain good oral hygiene (teeth and gums) and have regular check-ups with your dentist, Avoid body piercing and tattooing, Dont inject recreational drugs, Download and fill out the ICE card in the attachment below and carry it with you in case of emergency.

• #19 Infective Endocarditis Clinical Practice Guideline | American Dental Association

  https://www.ada.org/resources/research/science-and-research-institute/evidence-based-dental-research/infective-endocarditis-clinical-practice-guideline

  For infective endocarditis prophylaxis, current guidelines support premedication for a relatively small subset of patients. This is based on a review of scientific evidence, which showed that the risk of adverse reactions to antibiotics generally outweigh the benefits of prophylaxis for many patients who would have been considered eligible for prophylaxis in previous versions of the guidelines. Concern about the development of drug-resistant bacteria also was a factor. […] Infective endocarditis prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. For patients with these underlying cardiac conditions, prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa.

• #20 Infective Endocarditis Prophylaxis | University Hospitals | Cleveland, OH | University Hospitals

  https://www.uhhospitals.org/rainbow/for-clinicians/specialties/congenital-heart-collaborative/practice-tools/infective-endocarditis-prophylaxis

  For highest-risk patients, prophylaxis is appropriate for all dental procedures that involve: […] Antibiotic prophylaxis is also recommended for highest-risk patients in the case of an invasive procedure involving incision or biopsy of the respiratory mucosa, such as: […] In highest-risk patients, prophylaxis is also recommended for procedures involving infected skin, skin structures or musculoskeletal tissue.

• #21 Endocarditis Prophylaxis Antibiotic Dosing | Smiles for Life Oral Health

  https://www.smilesforlifeoralhealth.org/topic/endocarditis-prophylaxis-antibiotic-dosing/

  Endocarditis Prophylaxis Antibiotic Dosing […] Current American Heart Association guidelines for antibiotic dosing are: […] Amoxicillin: Adults: 2 g; children: 50 mg/kg orally one hour before procedure […] If allergic to penicillin, use: […] Clindamycin: Adults: 600 mg; children: 20 mg/kg orally one hour before procedure […] Cephalexin or cefadroxil: Adults: 2 g; children: 50 mg/kg orally one hour before procedure […] Azithromycin or clarithromycin: Adults: 500 mg; children: 15 mg/kg orally one hour before procedure […] Cephalosporins should not be used in individuals with immediate-type hypersensitivity reaction to penicillins. […] Considerations […] A single dose of antibiotic covers the expected period of bacteremia. […] Optimal timing of dose is the 2 hour window before procedure. […] The maximum calculated dose for children should not exceed the adult dose. […] If patients are unable to take oral agents, consult the American Heart Association for the IV or IM recommendations at www.americanheart.org. […] These guidelines change periodically. Check for updates.

• #22

  https://bpac.org.nz/bpj/2015/june/endocarditis.aspx

  Amoxicillin is the first-line prophylactic antibiotic for people undergoing invasive dental procedures who are at high risk of developing endocarditis. […] If the patient inadvertently does not receive an antibiotic prior to the dental procedure, it may be administered up to two hours later, although the effectiveness of the prophylaxis may be reduced. […] The principle reason for the reduction in antibiotic use was that the risk of a person developing infective endocarditis following a dental procedure is very low, even for those with a high lifetime risk. […] In 2008, the United Kingdom National Institute for Health and Care Excellence (NICE) went one step further than other groups and recommended that antibiotics should no longer be prescribed solely for the prevention of infective endocarditis, regardless of the patients risk. […] Over 60 years of published data still do not provide evidence on which to make strong recommendations for antibiotic prophylaxis against endocarditis at the time of dental procedures.

• #23 A review of recommendations for infective endocarditis prevention in patients undergoing transcatheter aortic valve implantation | EuroIntervention

  https://eurointervention.pcronline.com/article/a-review-of-recommendations-for-infective-endocarditis-prevention-in-patients-undergoing-transcatheter-aortic-valve-implantation

  Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is a new disease entity. […] Guidelines on infection prevention measures before TAVI procedures are currently lacking. […] Antibiotic prophylaxis should be adapted from an intravenous cephalosporin to, e.g., amoxicillin/clavulanic acid, to cover enterococci. […] Infection control should follow operating room standards as far as is reasonable, even if the evidence for this recommendation is very low. […] The current recommendation for antibiotic prophylaxis for TAVI has been adapted from SAVR routine and includes a cephalosporin focusing on the coverage of the most common pathogen in surgical site infection after cardiac surgery, namely Staphylococcus spp. However, cephalosporins are inherently not active against Enterococcus spp., which belongs to the most commonly isolated pathogens from IE after TAVI.

• #23 A review of recommendations for infective endocarditis prevention in patients undergoing transcatheter aortic valve implantation | EuroIntervention

  https://eurointervention.pcronline.com/article/a-review-of-recommendations-for-infective-endocarditis-prevention-in-patients-undergoing-transcatheter-aortic-valve-implantation

  Therefore, antibiotic prophylaxis prior to performing TAVI should be changed from an IV cephalosporin to, e.g., IV amoxicillin/clavulanic acid or an alternative, if the patient is allergic or colonised with resistant pathogens. […] Prevention should follow OR recommendations as far as reasonable, even if the evidence for this recommendation is very limited. […] Every patient should be instructed about personal measures to prevent IE after TAVI, including compliance with strict dental hygiene and with non-specific prevention measures such as no self-medication with antibiotics in case of fever, the renouncement of piercing and tattooing and the timely limitation of intravascular catheters. […] Patients with a TAVI prosthesis should receive an endocarditis prophylaxis document describing prophylactic antibiotic use in different medical interventions such as dental, gastrointestinal, urogenital and infected skin interventions.

• #24 Indications for antibiotic prophylaxis to prevent infective endocarditis in adults

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Indications-for-antibiotic-prophylaxis-to-prevent-infective-endocarditis-in-adults

  It remains unclear as to whether AP is effective. It is a subject which divides clinicians. […] At present, the ESC guideline committee believes that it is reasonable to give AP to patients at high risk of IE, as the risks and costs of AP are small and the potential consequences to a patient are devastating. […] Until more evidence is available, this is a pragmatic and reasonable stance to take.

• #25 Avoid prophylactic antibiotics for the treatment of mitral valve prolapse. | AAFP

  https://www.aafp.org/pubs/afp/collections/choosing-wisely/257.html

  Antibiotic prophylaxis is no longer indicated in patients with mitral valve prolapse for prevention of infective endocarditis. The risk of antibiotic-associated adverse effects exceeds the benefit (if any) from prophylactic antibiotic therapy. […] Limited use of prophylaxis will likely reduce the unwanted selection of antibiotic-resistant strains and their unintended consequences such as Clostridium difficileassociated colitis.

• #26 Infective Endocarditis Antibiotic Prophylaxis After Dental Procedures

  https://www.acc.org/Latest-in-Cardiology/Journal-Scans/2024/04/15/12/58/antibiotic-prophylaxis-and-ie

  After extensive literature review, data from case-control/crossover, cohort, and self-controlled case series studies showed that the use of antibiotic prophylaxis was associated with a reduced risk of infective endocarditis (IE) following an invasive dental procedure among individuals at high risk, whereas no association was proven for those at low/unknown risk. […] Meta-analysis based on four substudies in two prior publications revealed a 59% reduction in relative risk of IE associated with antibiotic prophylaxis after invasive dental procedures among individuals at high risk. […] Although results from time-trend studies were inconsistent, data from case-control/crossover, cohort, and self-controlled case series studies showed that the use of antibiotic prophylaxis is associated with reduced risk of IE following invasive dental procedures in individuals at high risk, while no association was proven for those at low/unknown risk; thereby supporting current American Heart Association and European Society of Cardiology recommendations. […] This study provides evidence to support the continued use of antibiotic prophylaxis among patients at high risk for IE undergoing an invasive dental procedure.

• #27 Antibiotic prophylaxis for patients at risk of infective endocarditis: an increasing evidence base?

  https://bjcardio.co.uk/2023/02/antibiotic-prophylaxis-for-patients-at-risk-of-infective-endocarditis-an-increasing-evidence-base/

  The NICE/SDCEP advice, therefore, still lacks the preciseness and clarity of the ESC and AHA guidance. […] In light of the Montgomery versus Lanarkshire Health Board ruling, and the SDCEP implementation advice, as well as current AHA and ESC recommendations, it is now essential that patients at high risk are told about the potential risks and benefits of AP prior to embarking on an invasive dental procedure. […] This study supports current ESC and AHA guidance, and contradicts the current NICE guideline recommendations, by providing evidence to support the recommendation that those at high IE risk should receive AP before invasive dental procedures. […] The recent data demonstrating a significant association between invasive dental procedures (particularly dental extractions and oral surgery procedures) and IE, and the data showing that AP significantly reduced the incidence of IE for patients at high IE risk undergoing these procedures, suggest it is time NICE consider revising its guidelines, in light of the new evidence, to better align with ESC and AHA guidelines recommending AP for those at highest IE-risk.

• #28

  https://link.springer.com/article/10.1007/s11908-017-0564-y

  In 2006, BSAC published new AP recommendations for the UK and, supported by a Cochrane review, argued that there was no evidence to support the use of AP during invasive dental procedures. […] In March 2008, the NICE revealed the outcome of its review, and to the disbelief and shock of many cardiologists and cardiothoracic surgeons, recommended the complete cessation (for all procedures and all patients) of AP to prevent IE. […] The 2008 NICE guidelines recommended the complete cessation of AP in the UK where previously it had been recommended for those at moderate and high risk of IE. […] The NICE deemed that there was insufficient evidence to warrant any change to their existing guidance and continued to recommend against AP. In contrast, the ESC concluded that the weight of evidence and opinion is in favour of the efficacy and usefulness of AP in preventing IE in those at high-risk. […] The concept of AP to prevent IE has changed considerably since it was first formally introduced in the AHA guidelines of 1955.

• #28

  https://link.springer.com/article/10.1007/s11908-017-0564-y

  Links between infective endocarditis (IE) and dental and other invasive procedures were first identified in the 1920s, and the use of antibiotic prophylaxis (AP) to prevent IE was first recommended by the American Heart Association in 1955. […] In the UK, the National Institute for Health and Care Excellence controversially recommended the complete cessation of AP for all invasive procedures in 2008 and subsequent epidemiological studies have suggested a significant increase in cases above the baseline trend. AP appears to be safe and is likely to be cost-effective. Until further data are available, we recommend continued adherence to US and European guidelines. […] The first AHA guidelines identified those with rheumatic or congenital heart disease as being at increased risk of IE, and dental extraction and other dental manipulations which disturb the gums, the removal of tonsils and adenoids, the delivery of pregnant women, and operations on the gastrointestinal or urinary tracts as procedures where AP was indicated.

• #29 New evidence calls into question NICE’s endocarditis prevention guidance | British Dental Journal

  https://www.nature.com/articles/s41415-024-7344-5

  In 2008, National Institute for Health and Care Excellence (NICE) guidelines recommended against the use of antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) to prevent infective endocarditis (IE). […] In 2015, NICE reviewed its guidance and continued to recommend against AP. However, it subsequently changed its wording to antibiotic prophylaxis against infective endocarditis is not routinely recommended’. […] Since the 2015 guideline review, new data have confirmed an association between IDPs and subsequent IE and demonstrated AP efficacy in reducing IE risk following IDPs in high-risk patients. […] Given the new evidence, a NICE guideline review would seem appropriate so that UK high-risk patients can receive the same protection afforded high-risk patients in the rest of the world.

• #29 New evidence calls into question NICE’s endocarditis prevention guidance | British Dental Journal

  https://www.nature.com/articles/s41415-024-7344-5

  National Institute for Health and Care Excellence (NICE) guidelines for the prevention of infective endocarditis (IE) are almost unique worldwide in not recommending routine antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) in patients at high risk of IE. […] Recent data confirm an association between IDPs and subsequent IE and show that AP is safe, cost-effective and significantly reduces the incidence of IE following IDPs in those at high IE risk. […] Re-introduction of AP for those at high risk could potentially prevent 41-261 IE cases in the UK each year (including ~12-78 deaths) and produce substantial cost savings for the NHS. […] Given this new evidence, it is time for NICE to review its recommendations so that patients in the UK receive the same protection against IE as others in the rest of the world.

• #29 New evidence calls into question NICE’s endocarditis prevention guidance | British Dental Journal

  https://www.nature.com/articles/s41415-024-7344-5

  All studies described herein have been published since the last review of NICE guidance in 2015 and demonstrate the importance of improving oral hygiene, confirm the association between IDPs and IE, and prove that AP is safe, efficacious and cost-effective. […] In the light of this new evidence, the potential to save lives, improve patient care and save scarce NHS resources, we believe that a review of NICE guidance is now essential to allow a consistent international approach to the prevention of IE and its complications.

• #30 Prevention of infective endocarditis associated with dental interventions

  https://scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162018000200010

  All Expert Committees on IE prevention agree that the maintenance of optimal oral hygiene (by regular professional dental care and the appropriate use of manual, powered and ultrasonic toothbrushes, dental floss and other plaque-removal devices) is the most effective intervention for the prevention of IE of oral origin. […] SA Heart recommends antibiotic prophylaxis to individuals with the greatest risk of an adverse outcome with IE (outlined in Table 1, in addition to those with RHD, undergoing the procedures described in Table II). We again emphasise the maintenance of optimal oral health, which is likely to play the most important role in protecting those at risk of IE, in addition to the education of patients in this regard. There should be close cooperation between the dental practitioner/physician/paediatrician/cardiologist/cardiac surgeon as to who should receive prophylaxis and who should not.

• #31 Endocarditis in Children with Heart Defects

  https://www.rch.org.au/cardiology/parent_info/Endocarditis_in_Children_with_Heart_Defects/

  Recently significant changes to the prophylaxis guidelines have been made with more restricted indications. […] Children at risk should establish and maintain the best possible oral health to reduce potential sources of bacteraemia which includes tooth brushing and regular dental review. […] Single dose antibiotic prophylaxis is now only recommended for children with the highest risk of adverse outcome of infective endocarditis (see Table 1). […] In certain individual circumstances, medical and dental practitioners may consider giving antibiotics to patients not covered by these revised guidelines including those who have received prophylaxis over their lifetime. Recommendations for individual patients should be discussed with the treating cardiologist. […] At risk procedures that require prophylaxis include: Dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa, Invasive respiratory procedures (incision or biopsy of respiratory mucosa – including tonsillectomy and adenoidectomy), Invasive genitourinary and gastrointestinal procedures.

• #32 AHA 2021 Statement on Prevention of Infective Endocarditis

  https://www.rcdso.org/en-ca/standards-guidelines-resources/rcdso-news/articles/6233

  The American Heart Association (AHA) has issued an update to its 2007 guideline entitled Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement from the American Heart Association. […] Antibiotic prophylaxis (AP) before dental procedures may prevent an extremely small number of VGS IE cases. Accordingly, AP is suggested only for patients with the highest risk of an adverse outcome from VGS IE. […] Maintaining good oral health and accessing regular dental care is considered more important than antibiotic prophylaxis before a dental procedure to prevent VSG IE. […] It is important that dentists become familiar with the 2021 AHA suggestions so that patients can make an informed decision about the risks and benefits of AP before dental procedures.

• #33

  https://link.springer.com/article/10.1007/s15010-022-01900-0

  The present investigation suggests that prescribing AP before dental procedures may prevent the risk of developing IE in high-risk patients, based on a single prospective cohort study. […] Therefore, these results are consistent with the current AHA and ESC Guidelines, advising AP in patients at elevated risk of IE who have to undergo a dental procedure. […] However, no prospective, randomized, placebo-controlled trial has been performed to confirm or refute the usefulness of AP for patients undergoing dental procedures. […] Taken together, our systematic review indicates a lack of evidence whether AP before dental procedures indeed prevents IE, especially for patients at low and moderate risk.

• #34 Infective Endocarditis Prophylaxis

  https://prescribingcompanion.com/tanzania/infections-and-infectious-diseases-prescribing/cardiovascular-disease-conditions/infective-endocarditis-prophylaxis/

  Antibiotic prophylaxis is not recommended for respiratory tract procedures including bronchoscopy or laryngoscopy, or transnasal or endotracheal intubation […] gastrointestinal or urogenital procedures or transoesophageal echocardiogram, gastroscopy, colonoscopy, cystoscopy, vaginal or caesarean delivery […] skin and soft tissue procedures.

• #35 Endocarditis Prophylaxis | Smiles for Life Oral Health

  https://www.smilesforlifeoralhealth.org/topic/endocarditis-prophylaxis/

  A systems-based approach is required to care for patients who require antibiotic prophylaxis for oral procedures. […] The following questions should be asked and addressed in accordance with the 2007 American Heart Association Guidelines. This process requires collaboration with the patient’s dentist and/or cardiologist. […] Does the patient have a medical condition placing him or her at high risk for endocarditis? […] Does the oral procedure being performed present a substantial risk of bacteremia? […] If the answer to both of the preceding questions is yes, which antibiotic is recommended?

• #36 Infective endocarditis: Prophylaxis – NYSORA

  https://www.nysora.com/anesthesia/infective-endocarditis-prophylaxis/

  Infective endocarditis: Prophylaxis […] Learning objectives […] – Prevent infective endocarditis […] Definition […] – Infective endocarditis (IE) is a life-threatening infection of the endothelial lining of the heart’s chambers and heart valves […] Prophylaxis […] – The absolute risk for IE is very low, and while antibiotics given at the right indication lower the incidence of IE they do not prevent all cases of IE […] […] – Antibiotic use poses the risk of anaphylaxis or bacterial resistance […] […] – Consider the pros and cons when giving IE prophylaxis, only use antibiotics for high-risk patients undergoing high-risk procedures […] Use oral antibiotics as the first choice. Alternatively, use cephalexin 2 g (50 mg/kg IV for children), cefazolin, or ceftriaxone 1 g IV (50 mg/kg IV for children)

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