This Article Free upon publication Full Text Full Text (PDF) All Versions of this Article: 116/15/1736    most recent CIRCULATIONAHA.106.183095v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wilson, W. Search for Related Content PubMed PubMed Citation Articles by Wilson, W. Pubmed/NCBI databases Medline Plus Health Information Joint Disorders Related Collections Infectious endocarditis Primary prevention

(Circulation. 2007;116:1736-1754.)
© 2007 American Heart Association, Inc.

AHA Guideline

Prevention of Infective Endocarditis

Guidelines From the American Heart Association: A Guideline From 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

Walter Wilson, MD, Chair; Kathryn A. Taubert, PhD, FAHA; Michael Gewitz, MD, FAHA; Peter B. Lockhart, DDS; Larry M. Baddour, MD; Matthew Levison, MD; Ann Bolger, MD, FAHA; Christopher H. Cabell, MD, MHS; Masato Takahashi, MD, FAHA; Robert S. Baltimore, MD; Jane W. Newburger, MD, MPH, FAHA; Brian L. Strom, MD; Lloyd Y. Tani, MD; Michael Gerber, MD; Robert O. Bonow, MD, FAHA; Thomas Pallasch, DDS, MS; Stanford T. Shulman, MD, FAHA; Anne H. Rowley, MD; Jane C. Burns, MD; Patricia Ferrieri, MD; Timothy Gardner, MD, FAHA; David Goff, MD, PhD, FAHA; David T. Durack, MD, PhD; The Council on Scientific Affairs of the American Dental Association has approved the guideline as it relates to dentistry. In addition, this guideline has been endorsed by the American Academy of Pediatrics, Infectious Diseases Society of America, the International Society of Chemotherapy for Infection and Cancer, and the Pediatric Infectious Diseases Society.^*

Background— The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective endocarditis that were last published in 1997.

Methods and Results— A writing group was appointed by the AHA for their expertise in prevention and treatment of infective endocarditis, with liaison members representing the American Dental Association, the Infectious Diseases Society of America, and the American Academy of Pediatrics. The writing group reviewed input from national and international experts on infective endocarditis. The recommendations in this document reflect analyses of relevant literature regarding procedure-related bacteremia and infective endocarditis, in vitro susceptibility data of the most common microorganisms that cause infective endocarditis, results of prophylactic studies in animal models of experimental endocarditis, and retrospective and prospective studies of prevention of infective endocarditis. MEDLINE database searches from 1950 to 2006 were done for English-language papers using the following search terms: endocarditis, infective endocarditis, prophylaxis, prevention, antibiotic, antimicrobial, pathogens, organisms, dental, gastrointestinal, genitourinary, streptococcus, enterococcus, staphylococcus, respiratory, dental surgery, pathogenesis, vaccine, immunization, and bacteremia. The reference lists of the identified papers were also searched. We also searched the AHA online library. The American College of Cardiology/AHA classification of recommendations and levels of evidence for practice guidelines were used. The paper was subsequently reviewed by outside experts not affiliated with the writing group and by the AHA Science Advisory and Coordinating Committee.

Conclusions— The major changes in the updated recommendations include the following: (1) The Committee concluded that only an extremely small number of cases of infective endocarditis might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100% effective. (2) Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. (3) For patients with these underlying cardiac conditions, prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. (4) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective endocarditis. (5) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure. These changes are intended to define more clearly when infective endocarditis prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations.

Key Words: AHA Scientific Statements • cardiovascular diseases • endocarditis • prevention • antibiotic prophylaxis

This article has been cited by other articles:

				J. Muenzer, J. E. Wraith, L. A. Clarke, and and the International Consensus Panel on the Manag Mucopolysaccharidosis I: Management and Treatment Guidelines Pediatrics, January 1, 2009; 123(1): 19 - 29. [Abstract] [Full Text] [PDF]

				P. Gazzaniga, E. Buscarini, G. Leandro, L. Reduzzi, M. Grosso, G. Pongiglione, C. Pedrinazzi, L. Lanzarini, V. Portugalli, P. Blotta, et al. Contrast echocardiography for pulmonary arteriovenous malformations screening: does any bubble matter? Eur J Echocardiogr, December 17, 2008; (2008) jen317v1. [Abstract] [Full Text] [PDF]

				C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 2, 2008; 52(23): e143 - e263. [Full Text] [PDF]

				C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, December 2, 2008; 118(23): e714 - e833. [Full Text] [PDF]

				C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, December 2, 2008; 118(23): 2395 - 2451. [Full Text] [PDF]

				2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, October 7, 2008; 118(15): e523 - e661. [Full Text] [PDF]

				R. A. Nishimura, B. A. Carabello, D. P. Faxon, M. D. Freed, B. W. Lytle, P. T. O'Gara, R. A. O'Rourke, and P. M. Shah ACC/AHA 2008 Guideline Update on Valvular Heart Disease: Focused Update on Infective Endocarditis: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, August 19, 2008; 118(8): 887 - 896. [Full Text] [PDF]

				T Stokes, R Richey, D Wrayon, and on behalf of the Guideline Development Group Prophylaxis against infective endocarditis: summary of NICE guidance Heart, July 1, 2008; 94(7): 930 - 931. [Full Text] [PDF]

				B D Prendergast, J L Harrison, and C K Naber Commentary on endocarditis prophylaxis: a quaint custom or medical necessity? Heart, July 1, 2008; 94(7): 931 - 934. [Full Text] [PDF]

				T. F. Oswald and F. K. Gould Dental treatment and prosthetic joints: ANTIBIOTICS ARE NOT THE ANSWER! J Bone Joint Surg Br, July 1, 2008; 90-B(7): 825 - 826. [Abstract] [Full Text] [PDF]

				I. Uckay, D. Pittet, L. Bernard, D. Lew, A. Perrier, and R. Peter Antibiotic prophylaxis before invasive dental procedures in patients with arthroplasties of the hip and knee J Bone Joint Surg Br, July 1, 2008; 90-B(7): 833 - 838. [Abstract] [Full Text] [PDF]

				P. B. Lockhart, M. T. Brennan, H. C. Sasser, P. C. Fox, B. J. Paster, and F. K. Bahrani-Mougeot Bacteremia Associated With Toothbrushing and Dental Extraction Circulation, June 17, 2008; 117(24): 3118 - 3125. [Abstract] [Full Text] [PDF]

				X. Duval, C. Leport, and N. Danchin The new American Heart Association guidelines on the prevention of infective endocarditis: culmination of a long process of thought Heart, June 1, 2008; 94(6): 715 - 716. [Full Text] [PDF]

				N. Herring and D. C Sprigings A call for national monitoring of antibiotic prophylaxis BMJ, May 3, 2008; 336(7651): 976 - 976. [Full Text] [PDF]

				S.-M. R. Y. Geist and J. R. Geist Improvement in Medical Consultation Responses with a Structured Request Form J Dent Educ., May 1, 2008; 72(5): 553 - 561. [Abstract] [Full Text] [PDF]

				M. Silberbach Update: Infective Endocarditis Prophylaxis: Reckoning With the Evidence Pediatr. Rev., May 1, 2008; 29(5): 169 - 170. [Full Text] [PDF]

				H. U Rehman Antiobiotic prophylaxis is different in guidelines BMJ, March 22, 2008; 336(7645): 630 - 630. [Full Text] [PDF]

				A. J. Mittnacht, M. Fanshawe, and S. Konstadt Anesthetic Considerations in the Patient With Valvular Heart Disease Undergoing Noncardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2008; 12(1): 33 - 59. [Abstract] [PDF]

				S. H. Rahimtoola The Year in Valvular Heart Disease. J. Am. Coll. Cardiol., February 19, 2008; 51(7): 760 - 770. [Full Text] [PDF]

				D. Danford Endocarditis Prophylaxis: Do We Have It Right This Time? AAP Grand Rounds, February 1, 2008; 19(2): 13 - 14. [Full Text] [PDF]

				W. Rosamond, K. Flegal, K. Furie, A. Go, K. Greenlund, N. Haase, S. M. Hailpern, M. Ho, V. Howard, B. Kissela, et al. Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 29, 2008; 117(4): e25 - e146. [Full Text] [PDF]

				D. B. Blossom, F. M.T. Lewis, and L. C. McDonald The Changing Spectrum of Clostridium Difficile Associated Disease: Implications for Dentistry J Am Dent Assoc, January 1, 2008; 139(1): 42 - 47. [Abstract] [Full Text] [PDF]

				P. B. Lockhart Guidelines for prevention of infective endocarditis: An explanation of the changes J Am Dent Assoc, January 1, 2008; 139(suppl_1): 2S - 2S. [Full Text] [PDF]

				W. Wilson, K. A. Taubert, M. Gewitz, P. B. Lockhart, L. M. Baddour, M. Levison, A. Bolger, C. H. Cabell, M. Takahashi, R. S. Baltimore, et al. Prevention of infective endocarditis: Guidelines from the American Heart Association: A guideline from 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 J Am Dent Assoc, January 1, 2008; 139(suppl_1): 3S - 24S. [Abstract] [Full Text] [PDF]

				An updated legal perspective on antibiotic prophylaxis: American Dental Association Division of Legal Affairs J Am Dent Assoc, January 1, 2008; 139(suppl_1): 10S - 10S. [Full Text] [PDF]

				S. A. Bernard Heart Disease in Pregnancy. Second Edition. Circulation, January 1, 2008; 117(1): e3 - e4. [Full Text] [PDF]