Antibiotic prophylaxis to prevent endocarditis

NICE suggest that healthcare professionals should regard people with the following cardiac conditions as being at risk of developing infective endocarditis:

• acquired valvular heart disease with stenosis or regurgitation
• valve replacement
• structural congenital heart disease, including surgically corrected or palliated structural conditions, but excluding isolated atrial septal defect, fully repaired ventricular septal defect or fully repaired patent ductus arteriosus, and closure devices that are judged to be endothelialised
• previous infective endocarditis
• hypertrophic cardiomyopathy

NICE have also given guidance concerning use of antibiotic prophylaxis against infective endocarditis

• antibiotic prophylaxis against infective endocarditis is not recommended:
  • for people undergoing dental procedures
  • for people undergoing non-dental procedures at the following sites : -
    • upper and lower gastrointestinal tract
    • genitourinary tract; this includes urological, gynaecological and obstetric procedures, and childbirth
    • upper and lower respiratory tract; this includes ear, nose and throat procedures and bronchoscopy
  • chlorhexidine mouthwash should not be offered as prophylaxis against infective endocarditis to people at risk of infective endocarditis undergoing dental procedures
• infection
  • any episodes of infection in people at risk of infective endocarditis should be investigated and treated promptly to reduce the risk of endocarditis developing.
  • if a person at risk of infective endocarditis is receiving antimicrobial therapy because they are undergoing a gastrointestinal or genitourinary procedure at a site where there is a suspected infection, the person should receive an antibiotic that covers organisms that cause infective endocarditis.

Reference:

• (1) NICE (2008). Prophylaxis against infective endocarditis Antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures