SBE Prophylaxis Guidelines

Antibiotic prophylaxis guidelines were updated by a cooperative effort including workgroups from the American Heart Association (AHA) and the American Dental Association (ADA) in 2007.

It was recognized that although infective endocarditis (IE) is associated with a high morbidity and mortality; it is still a relatively rare clinical entity, with approximately 15,000 new cases diagnosed annually in the USA. The incidence of community-acquired native-valve endocarditis is 1.7 to 6.2 cases per 100,000, with men affected more often than women. It was noted that the effect of routine antibiotic prophylaxis on the development of selective drug resistance and the development of immediate and delayed-type drug reactions is unknown. Conditions which are associated with a greater incidence of IE include: poor dental hygiene, diabetes mellitus, and long-term hemodialysis. Other predisposing factors include: intravenous drug use, prosthetic heart valves, degenerative valve sclerosis, and invasive procedures that create a risk for bacteremia.

Recent epidemiologic data have revealed staphylococci and viridans streptococci as the leading causes of IE.

Prophylactic use of antibiotics prior to dental procedures are currently recommended only for patients with: artificial heart valves, a prior history of IE, un-repaired or incompletely repaired cyanotic congenital heart diseases (including those with palliative shunts and conduits, a completely repaired congenital heart defect using prosthetic material or device during the first six months after the procedure, and any repaired congenital heart defect with a residual defect at the site of or adjacent to the site of a prosthetic patch or a prosthetic device), a history of cardiac transplantation that develops a problem in a heart valve.

Antibiotics to prevent IE are no longer recommended for genitourinary and gastrointestinal procedures.

The recommended regimen for prophylaxis is amoxicillin or ampicillin 2 gm (50 mg/kg) or cephalexin 2 gm (50 mg/kg), clindamycin 600 mg (20 mg/kg), azithromycin 500 mg (15 mg/kg), clarithromycin 500 mg (15 mg/kg), cephazolin 1 gm (50 mg/kg), or ceftriaxone 1 gm (50 mg/kg) for penicillin/ampicillin allergic patients.

Wilson S, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis. Guidelines from the American Heart Association. A Guideline form 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; 115:1656-8