Antibiotic prophylaxis is recommended for patients with heart condition that may develop to infective endocarditis.
The latest recommendation by American Heart Association (AHA) in 2008 recommends new protocols based on the pros and cons of the risk of adverse reactions to antibiotics and possibility of development of drug-resistant bacteria versus the benefits of prophylaxis for most patients.
The complete recommendations, including the recommended regimen, can be found in:
New researches indicate that people who are at risk for IE are regularly exposed to oral flora during basic daily activities such as brushing or flossing, suggesting that IE is more likely to occur as a result of these everyday activities than from a dental procedure.
The current recommendations recommend use of preventive antibiotics prior to certain dental procedures for patients with:
- artificial heart valves
- a history of infective endocarditis
- a cardiac transplant that develops a heart valve problem
- the following congenital (present from birth) heart conditions:*
- unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
- a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
- any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device
* Patients should check with their cardiologist if there is any question as to whether they fall into one of these categories.
Patients who took prophylactic antibiotics in the past but no longer need them include those with:
- mitral valve prolapse
- rheumatic heart disease
- bicuspid valve disease
- calcified aortic stenosis
- congenital (present from birth) heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy
Prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of the teeth, or perforation of the oral mucosa.
Additional considerations about antibiotic prophylaxis
Sometimes patients forget to premedicate prior to their appointments. The recommendation is that the antibiotic be given before the procedure. This is important because it allows the antibiotic to reach adequate blood levels. However, the recommendations to prevent infective endocarditis state:
“If the dosage of antibiotic is inadvertently not administered before the procedure, the dosage may be administered up to two hours after the procedure.”
Another concern that dentists have expressed involves patients who require prophylaxis but are already taking antibiotics for another condition. In these cases, the recommendations for infective endocarditis recommend that the dentist select an antibiotic from a different class than the one the patient is already taking. For example, if the patient is taking amoxicillin, the dentist should select clindamycin, azithromycin or clarithromycin for prophylaxis