Antibiotic Prophylaxis

CHAPTER 221 Antibiotic Prophylaxis

Antibiotic Prophylaxis for Infective Endocarditis

The publication of new American Heart Association guidelines for the prevention of infective endocarditis by Wilson and associates (2007) in Circulation represents a major change. The American Heart Association originally published guidelines for infective endocarditis prevention in 1955. Before the 2007 update, the last changes were in 1997. Since that time, the efficacy of antimicrobial prophylaxis to prevent infective endocarditis in patients undergoing dental, gastrointestinal, and genitourinary procedures has been questioned by many groups. Those seeking further discussion beyond that presented here are referred to the American Heart Association guideline.

Major changes in the guidelines include the following:

Box 221-1 lists the conditions that are at highest risk for poor outcomes with infective endocarditis and should therefore be considered for prophylaxis with antibiotics for some procedures. No other cardiac conditions should be considered for prophylaxis for any dental, gastrointestinal, or genitourinary procedures.

Prior recommendations separated dental procedures into those for which prophylaxis was or was not recommended, based on risk of bacteremia and subsequent development of infective endocarditis. The updated recommendations indicate prophylaxis for any dental procedure that might involve manipulation of the gingival tissues or apical region of the teeth or perforation of the oral mucosa, including teeth cleaning, only for those at high risk (see Box 221-1). Box 221-2 lists dental procedures for which antibiotic prophylaxis is not recommended for anyone.

May 14, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Antibiotic Prophylaxis

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