Infectious endocarditis is an uncommon, potentially life-threatening disease. Recommendations for prophylaxis have been published for more than 50 years. Traditionally, antibiotic prophylaxis has been given before dental and a number of other interventional procedures to many patient groups with cardiac conditions associated with increased risk of infectious endocarditis. Several changes in guidelines have been published in the last decade. The purpose of this study was to take a closer look at the changes in guidelines and to discuss the prophylaxis recommendations available today.
In this study, relevant international papers from 1997 to present date were detected via Medline/ PubMed and Internet sources. Papers relevant to the discussion of prevention of endocarditis were used.
All guidelines strongly advised good oral hygiene and regular dental care for the prevention of infectious endocarditis. Most of the guidelines also advised the use of prophylactic antibiotics, but only to patient groups with cardiac conditions associated with highest risk of infectious endocarditis and/or the highest risk of adverse outcome from the disease. Currently, the Norwegian and American Heart Associations advise antibiotic prophylaxis during high-risk dental procedures and invasive procedures in the respiratory tract; the European Society of Cardiology recommends prophylaxis only during dental procedures; and in the latest update from the National Institute of Clinical Excellence no antibiotic prophylaxis is recommended for any of the groups. There was no consensus for prophylactic guidelines related to body art procedures. Antithrombotic treatment was not included in any of the guidelines.
The trend during the last decade has been to reduce the use of antibiotic prophylaxis by recommending fewer doses, including fewer patient groups and procedures. The main reason for this seems to be lack of evidence for the effect of prophylaxis and the potential adverse effects in patients with severe allergy to antibiotics, in addition to the potential for developing resistant strains.