Infective Endocarditis Prevention

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Several times a year dental colleagues call asking about the “new” American Heart Association dental prophylaxis guidelines.

These guidelines have changed several times over the years and I thought it would be fitting to post an article of the most current recommendations (last revision 2008).

To try and simplify things we will focus on three W’s – Who, What, When.

I will also supply a link to the American Dental Association’s full recommendations on this topic later in the article.

Who

Patients should receive antibiotic prophylaxis prior to invasive dental treatment in the following circumstances:

  • They have artificial heart valves
  • They report a history of infective endocarditis
  • History of a cardiac transplant that develops a heart valve problem
  • Congenital (present from birth) heart conditions –  a broad and general description of these conditions are listed in the ADA guidelines but it is my opinion that a patient’s cardiologist should be consulted on which of these patients should receive prophylaxis

Pre treatment antibiotics are no longer recommended for the following:

  • mitral valve prolapse
  • rheumatic heart disease
  • bicuspid valve disease
  • calcified aortic stenosis
  • congenital (present from birth) heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy

What

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If a patient is currently on an one of the above indicated antibiotic agents, it is recommended a different antibiotic be used for prophylaxis.

For example, if a patient (requiring prophylaxis) has been taking Amoxicillin for an abscess then Clindamycin may be considered as a pre extraction prophylactic antibiotic agent.

When

Antibiotic prophylaxis should be performed when dental procedures that perforate the oral mucosa or involve gingival and periodical tissue treatments are planned.

Antibiotics should be taken prior to the actual treatment.  This is recommended in order to achieve optimal blood levels of the medication prior to invasive treatment.  I still use a “one hour before oral surgery” sig on prescriptions.

The guidelines do give a two hour post treatment window for antibiotic administration should the prophylaxis fail to be administered pre treatment.

As promised, here is a link to the full American Dental Association recommendations on antibiotic prophylaxis to prevent infective endocarditis:  http://is.gd/infectendocarditis

What questions do you have about this topic?

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