Guidelines for Antibiotic Prophylaxis
Updated April 2007.
The American Heart Association (AHA) released new guidelines for the prevention of infective endocarditis on
April 19, 2007. The AHA and the American Dental Association (ADA) now recommend that fewer dental
patients with heart disease receive antibiotic prophylaxis before dental procedures to prevent the heart infection
called infective endocarditis.
Conditions In Which Antibiotic Prophylaxis Is No Longer Recommended
Mitral valve prolapse
Rheumatic heart disease
Bicuspid valve disease
Calcified aortic stenosis
The following congenital heart conditions:
o Ventricular septal defect
o Atrial septal defect
o Hypertrophic Cardiomyopathy
Heart Conditions Requiring Antibiotic Prophylaxis
Artificial Heart Valves
History of Infective Endocarditis
Certain specific, serious congenital heart conditions including:
o Unrepaired or incompletely repaired cyanotic congenital heart disease, including those with
palliative shunts and conduits
o A completely repaired congenital heart defect with prosthetic material or device, whether placed
by surgery or by catheter intervention, during the first six months after the procedure
o Any repaired congenital heart defect with residual defect at the site or adjacent to the site of a
prosthetic patch or a prosthetic device
A cardiac transplant that develops a problem in a heart valve like valvulopathy
Joint Replacement Requiring Antibiotic Prophylaxis:
Total joint replacement for the first two years after surgery
Immunocompromised/immunosuppressed patients with total joint replacement:
o Inflammatory arthropathies (e.g. rheumatoid arthritis, systemic lupus erythematosus)
o Drug-induced immunosuppression
o Radiation-induced immunosuppression
Patients with co-morbidities with total joint replacement:
o Previous prosthetic joint infections
o Malnourishment
o Hemophilia
o HIV infection
o Insulin-dependent (Type 1) diabetes
o Malignancy
More information can be found at the following websites:
ADA.org
www.circ.ahajournals.org/rapidaccess.shtml (select April 19, 2007 abstract)
www.aaos.org/about/papers/advistmt/1014.asp
New guidelines published in the Circulation Journal.
Primary Reasons for Revision of the Infective Endocarditis Guidelines
IE is much more likely to result from frequent exposure to random bacteremias associated with daily
activities than from bacteremia caused by a dental, GI tract, or GU tract procedure.
Prophylaxis may prevent an exceedingly small number of cases of IE, if any, in individuals who
undergo a dental, GI tract, or GU tract procedure.
The risk of antibiotic-associated adverse events exceeds the benefit, if any, from prophylactic antibiotic
therapy.
Maintenance of optimal oral health and hygiene may reduce the incidence of bacteremia from daily
activities and is more important than prophylactic antibiotics for a dental procedure to reduce the risk of
IE.
The AHA concluded that only an extremely small number of cases of IE might be prevented by
antibiotic prophylaxis even if prophylaxis is 100% effective.
Antibiotic prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of
IE.