Endocarditis
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 - REVISED AHA GUIDELINES FOR PREVENTION OF INFECTIVE ENDOCARDITIS

 Antibiotics solely to prevent infective endocarditis are now recommended
 for only the highest-risk patients and, even in this group, for very few
 procedures.

 TARGET POPULATION: Physicians and dentists who perform procedures on
 patients with cardiac abnormalities

 SPONSORING ORGANIZATIONS: The American Heart Association, the American
 Dental Association, the Infectious Diseases Society of America, and the
 Pediatric Infectious Diseases Society

 TYPE: Evidence-based consensus statement from a multispecialist writing
 group. This document updates the American Heart Association's guidelines
 for prevention of infective endocarditis (IE), last revised in 1997.

 KEY POINTS: Recent findings have cast doubt on the benefits of antibiotic
 prophylaxis for dental procedures, because bacteremia associated with such
 procedures is usually transient, and transient bacteremia occurs much more
 commonly during routine daily activities (e.g., chewing and
 toothbrushing). In the absence of data demonstrating effectiveness of
 prophylaxis in reducing IE risk among people with cardiac abnormalities,
 the committee recommends offering prophylaxis to a more limited group. The
 committee believes that the risks of taking antibiotics are reasonable
 only for the patients most likely to benefit from these agents.

 Whereas previous guidelines stressed prophylaxis for patients undergoing
 the procedures deemed most likely to produce bacteremia, this document
 stresses prophylaxis for patients with cardiac conditions associated with
 the highest risk for adverse outcomes from IE. The list includes
 individuals with prosthetic heart valves; previous IE; unrepaired cyanotic
 congenital heart disease (including patients with palliative shunts and
 conduits); a congenital heart defect that was completely repaired with
 prosthetic material or device, whether placed by surgery or by catheter
 intervention, during the first 6 postprocedure months; repaired congenital
 heart disease with residual defect at, or adjacent to, the site of a
 prosthetic patch or prosthetic device; and cardiac valvulopathy following
 heart transplantation.

 Even for these high-risk patients, the only dental procedures for which
 antibiotic prophylaxis is recommended involve perforation of the oral
 mucosa or manipulation of the gingival tissue or the periapical region of
 teeth. Among these patients, prophylaxis may be considered for invasive
 respiratory-tract procedures that involve incision or biopsy of the
 respiratory mucosa. Antibiotic coverage for organisms likely to cause IE
 is recommended for high-risk individuals who undergo respiratory-tract
 procedures to treat established infections and those who undergo surgical
 procedures involving infected skin, skin structures, or musculoskeletal
 tissue. Antibiotic prophylaxis solely to prevent IE is no longer
 recommended for gastrointestinal tract or genitourinary tract procedures.
 However, for many of these procedures, prophylaxis is recommended to
 prevent sepsis or wound infection.

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