Thursday, April 19, 2007

New Guidelines for Endocarditis Prevention Published

Infective endocarditis (IE) is a devastating infection of the structures of the heart caused by blood-borne bacteria or fungi. These organisms can enter the blood stream during dental procedures involving infected tissues of the mouth. New guidelines were published before print today online in Circulation by the American Heart Association and the American Dental Association. The guidelines limit antibiotic prophylaxis to only those at highest risk of contracting endocarditis which are outlined below:
Cardiac Conditions Associated With the Highest Risk of Adverse Outcome From Endocarditis for Which Prophylaxis With Dental Procedures Is Recommended:
  • Prosthetic cardiac valve

  • Previous IE

  • Congenital heart disease (CHD)*

  • Unrepaired cyanotic CHD, including palliative shunts and conduits

  • Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure†

  • Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)

  • Cardiac transplantation recipients who develop cardiac valve abnormalities
- - -
*Except for the conditions listed above, antibiotic prophylaxis is no longer recommended for any other form of CHD.

†Prophylaxis is recommended because endothelialization of prosthetic material occurs within 6 months after the procedure.
Likewise, the antibiotic regimen has remained simplified, requiring only a single pre-procedure dose 30 to 60 minutes before dental work, with Ampicillin 2 grams orally (kids 50mg/kg) being the main antibiotic and Clindamycin (600 mg; kids 20 mg/kg) or Azithromycin or Clarithromycin (500 mg; kids 15 mg/kg) being suitable alternatives. Remarkably, gastrointestinal (GI) and genitourinary (GU) procedures no longer require antibiotic prophylaxis:
The administration of prophylactic antibiotics solely to prevent endocarditis is not recommended for patients who undergo GU or GI tract procedures, including diagnostic esophagogastroduodenoscopy or colonoscopy (Class III, Level of Evidence B). This is in contrast to previous AHA guidelines that listed GI or GU tract procedures for which infective endocarditis prophylaxis was recommended and those for which prophylaxis was not recommended.
You can find a full pdf file of the recommendations here.

-Wes

2 comments:

Anonymous said...

Thanks for the link to the Circ article.
Much simpler guidelines and eliminates the need for prophylaxis in most of our pts.

CardioNP

TBTAM said...

Thasks for this!