Cardiology Question 36 Instructor

Who still needs antibiotics prophylaxis as per the latest AHA/ADA guidelines published in 2007?

In 2007, the American Heart Association (AHA) and the American Dental Association (ADA) published the new guidelines on the prevention of infection endocarditis (IE) (1). Prophylactic antibiotics should not be given based on a lifetime risk for infective endocarditis alone, but are recommended for high-risk patients undergoing “procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa.”

Such “high-risk” patients, according to the guidelines, include those with the following:

  1. Prior infective endocarditis
  2. Prosthetic cardiac valves
  3. Unrepaired cyanotic congenital heart defects, including palliative shunts and conduits
  4. Congenital heart defects completely repaired with prosthetic material or a device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure
  5. Repaired congenital defects with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device
  6. Cardiac transplants and development of cardiac valvulopathy.

The latest document shifted the emphasis away from a focus on a dental procedure and antibiotic prophylaxis toward a greater emphasis on improved access to dental care and oral health among patients who are at highest risk of adverse outcome from IE, and those conditions that predispose to the acquisition of IE.

It is impractical to recommend antibiotic prophylaxis for routine daily activities for those high risk patients, such as chewing food, brushing, flossing, use of toothpicks, and use of water irrigation devices, etc.

The presence of dental disease may increase the risk of bacteremia associated with these routine activities. It is, therefore, even more important to recommend to these patients to have good dental hygiene by having routine dental check ups, as well as good teeth brushing and flossing routines.

Wilson W. et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007 Oct 9;116(15):1736-54

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