Antibiotic prophylaxis against infective endocarditis

The rule the whole topic turns on

Prophylaxis is for a high-risk patient PLUS a high-risk procedure. Both must be present. A high-risk heart having a procedure that is not high-risk gets nothing, and so does a high-risk procedure in a heart that is not on the list.

The American Heart Association and the American College of Cardiology have decreased the number of indications for antibiotic prophylaxis prior to dental procedures, so the list of hearts is short: a heart problem that is not on it is not given prophylaxis at all, even when the heart problem is real.

Which patients are high risk

One page gives the four groups:

• Prosthetic cardiac valve
• Previous IE
• Cardiac transplants with valvulopathy
• Congenital Heart Disease

The AHA and ACC are narrower on two of them. Currently antibiotics are indicated for prosthetic cardiac valves, previous infective endocarditis, unrepaired cyanotic congenital heart disease or a repaired congenital defect with a residual shunt, and a cardiac transplant with valve regurgitation due to a structurally abnormal valve. So congenital heart disease is included when it is unrepaired and cyanotic, or repaired with a residual shunt; and a transplant is included when it has valve regurgitation due to a structurally abnormal valve.

A previous episode of infective endocarditis is an indication however it arose, including endocarditis in her 20s that was related to intravenous drug use.