dr.ssar
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PREVENTION OF INFECTIVE ENDOCARDITIS --
GUIDELINES FROM THE AMERICAN HEART ASSOCIATION
A Guideline from the American Heart Association Rheumatic Fever, Endocarditis and
Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the
Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and
the Quality of Care and Outcomes Research Interdisciplinary Working Group
Walter Wilson, MD (Chair); Kathryn A. Taubert, PhD; Michael Gewitz, MD; Peter B. Lockhart,
DDS; Larry M. Baddour, MD; Matthew Levison, MD; Ann Bolger, MD; Christopher H. Cabell,
MD, MHS; Masato Takahashi, MD; Robert S. Baltimore, MD; Jane W. Newburger, MD, MPH;
Brian l. Strom, MD; Lloyd Y. Tani, MD; Michael Gerber, MD; Robert O. Bonow, MD; Thomas
Pallasch, DDS, MS; Stanford T. Shulman, MD; Anne H. Rowley, MD; Jane C. Burns, MD;
Patricia Ferrieri, MD; Timothy Gardner, MD; David Goff, MD, PhD; David T. Durack, MD, PhD.
The Council on Scientific Affairs of the American Dental Association has approved the paper as
it relates to dentistry. These guidelines have been endorsed by the Infectious Diseases Society
of America and by the Pediatric Infectious Diseases Society.
ABSTRACT
Background: The purpose of this statement is to update the recommendations by the
American Heart Association (AHA) for the prevention of infective endocarditis, which were last
published in 1997.
Methods and Results: A writing group appointed by the AHA for their expertise in prevention
and treatment of infective endocarditis with liaison members representing the American Dental
Association, the Infectious Diseases Society of America, and the American Academy of
Pediatrics. The writing group reviewed input from national and international experts on infective
endocarditis. The recommendations in this document reflect analyses of relevant literature
regarding procedure-related bacteremia and infective endocarditis, in vitro susceptibility data of
the most common microorganisms which cause infective endocarditis, results of prophylactic
studies in animal models of experimental endocarditis, and retrospective and prospective
studies of prevention of infective endocarditis. MEDLINE database searches from 1950-2006
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were done for English language papers using the following search terms: endocarditis, infective
endocarditis, prophylaxis, prevention, antibiotic, antimicrobial, pathogens, organisms, dental,
gastrointestinal, genitourinary, streptococcus, enterococcus, staphylococcus, respiratory, dental
surgery, pathogenesis, vaccine, immunization, and bacteremia. The reference lists of the
identified papers were also searched. We also searched the AHA online library. The American
College of Cardiology/American Heart Association classification of recommendations and levels
of evidence for practice guidelines were used. The paper
was subsequently reviewed by outside experts not affiliated with the writing group and by the
AHA Science Advisory and Coordinating Committee.
Conclusions: 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 should be recommended 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 recommended 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 of 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.
(*Note: Throughout this JADA document intended for dentistry, the reader will see references to
GI, GU and respiratory tract procedures, surgical procedures which involve infected skin, skin
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structures or musculoskeletal tissue, and some types of cardiac surgery. Reference to these
conditions has been retained in the narrative of this version of the AHA antibiotic prophylaxis
recommendations directed to dentistry because of the historical context of their inclusion by the
American Heart Association. However, the sections of the original AHA Infective Endocarditis
Recommendations that go into detail on these these conditions have been removed from the
current document. Interested readers should consult the full AHA Recommendations.
___________________
A bend in the road is not the END of it, unless you fail to make the TURN.
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