Antibiotic Prophylaxis for Prevention of Infective Endocarditis Clinical Practice Guidelines (2008)

With input from the ADA, the American Heart Association released guidelines for the prevention of infective endocarditis. The guidelines were approved by the ADA Council on Scientific Affairs as they relate to dentistry in 2008.

Key Points

  • For infective endocarditis prophylaxis, current guidelines support premedication for a relatively small subset of patients. This is based on a review of scientific evidence, which showed that the risk of adverse reactions to antibiotics generally outweigh the benefits of prophylaxis for many patients who would have been considered eligible for prophylaxis in previous versions of the guidelines. Concern about the development of drug-resistant bacteria also was a factor.
  • Infective endocarditis prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. For patients with these underlying cardiac conditions, prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa.