Use of Antibiotic Prophylaxis for Endocarditis Discouraged

Should not be given routinely for dental and other procedures
By A. Agrawal, PhD
HealthDay Reporter

TUESDAY, July 29 (HealthDay News) -- Antibiotic prophylaxis should no longer routinely be given to prevent infective endocarditis in patients undergoing dental and other medical procedures, according to updated guidelines published online July 28 in the Journal of the American College of Cardiology. The guidelines were jointly developed by the American College of Cardiology and the American Heart Association.

The updated guidelines note that antibiotic prophylaxis for dental procedures would prevent only a small number of cases of infective endocarditis and therefore should be given only for certain dental procedures to patients with underlying cardiac conditions that would put them at highest risk. The report also recommends that an increased lifetime risk of developing infective endocarditis is not a sufficient reason for antibiotic prophylaxis. Antibiotics should also not be given strictly to prevent endocarditis in patients undergoing procedures involving the genitourinary or gastrointestinal tract.

The reason for the changes, according to the report, is that infective endocarditis is more likely to be acquired through bacteremias associated with daily activities than medical procedures, and antibiotics would prevent a very small number of cases at best. Antibiotics also have possible adverse effects that may outweigh their benefit.

"The committee recognizes that decades of previous recommendations for patients with most forms of VHD (valvular heart disease) and other conditions have been abruptly changed by the new AHA guidelines," the report concludes. "Because this may cause consternation among patients, clinicians should be available to discuss the rationale for these new changes with their patients."

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