New guidelines for endocarditis prophylaxis: Infective endocarditis, also known as SBE for sub-acute bacterial endocarditis, is an uncommon but life-threatening disease. That is the reason why some patients with congenital heart defects may require antibiotics prior to dental work and certain types of invasive procedures or surgery, based on the premise that it will help prevent endocarditis. In May 2007, the American Heart Association issued their new recommendations for SBE prophylaxis. The new guidelines emphasize the need of optimal dental hygiene with regular dental brushing, at least 2-3 times a day, and flossing along with regular dental appointments.
A vast majority of patients with congenital heart defects will no longer require antibiotic prophylaxis based on:
1. Not being cost-effective.
2. Endocarditis is rare, especially in patients with good oral hygiene.
3. Endocarditis is usually associated with normal daily activities, rather than dental, gastrointestinal or genital-urinary interventions.
4. In most patients the risks outweigh the benefits of preventive antibiotics. A patient can develop a life-threatening allergic reaction to Amoxicillin. Prophylaxis may contribute to growing antibiotic resistance.
5. Reported cases of endocarditis in spite of the use of proper prophylaxis.
Therefore, prophylaxis is now limited to those cardiac conditions with the highest risk of adverse outcome from endocarditis (see AHA table 3). Practitioners may exercise their own judgment and choose to use SBE prophylaxis in other conditions.