New guidelines for endocarditis prophylaxis
Infective endocarditis, also known as SBE for sub-acute bacterial endocarditis, is an uncommon but life-threatening disease. That is the reason why some patients with congenital heart defects may require antibiotics prior to dental work and certain types of invasive procedures or surgery, based on the premise that it will help prevent endocarditis.
In May 2007, the American Heart Association issued their new recommendations for SBE prophylaxis. The new guidelines emphasize the need of optimal dental hygiene with regular dental brushing, at least 2-3 times a day, and flossing along with regular dental appointments.
A vast majority of patients with congenital heart defects will no longer require antibiotic prophylaxis based on:
- Not being cost-effective.
- Endocarditis is rare, especially in patients with good oral hygiene.
- Endocarditis is usually associated with normal daily activities, rather than dental, gastrointestinal or genital-urinary interventions.
- In most patients the risks outweigh the benefits of preventive antibiotics. A patient can develop a life-threatening allergic reaction to Amoxicillin. Prophylaxis may contribute to growing antibiotic resistance.
- Reported cases of endocarditis in spite of the use of proper prophylaxis.
Therefore, prophylaxis is now limited to those cardiac conditions with the highest risk of adverse outcome from endocarditis, such as patients with:
- Previous history of endocarditis.
- Cyanotic heart disease.
- Prosthetic valve or conduit.
- Prosthetic patch of device with a leak.
- At least 6 months after heart surgery or interventional procedure.
- Transplant or immune compromised patients with a defective heart valve(leakage or obstruction).
Practitioners may exercise their own judgment and choose to use SBE prophylaxis in other conditions.
Children's Heart Specialists, PSC is committed to provide comprehensive pediatric cardiac services to infants, children and young adults. We strive to insure the highest quality in non-invasive cardiovascular testing. Our medical staff is committed to being board certified in pediatric cardiology and adult congenital heart disease.
Our goal is to provide the highest quality of care with compassion and respect to our patients and their families.