83 - Prevention of Infective Endocarditis

Abstract

Prevention of infective endocarditis (IE) remains an important clinical goal involving multiple issues and potential interventions, not limited to antibiotic prophylaxis. Guidelines have evolved over recent years, notably toward highly restricted indications for antibiotic prophylaxis. Because no randomized clinical trials to confirm the efficacy and safety of antibiotic prophylaxis have ever been conducted, it is likely that the debate around indications for antibiotic prophylaxis of IE will continue for years to come. It is therefore reasonable to continue to recommend antibiotic prophylaxis for patients at highest risk of IE and its complications before they undergo high-risk dental procedures. Patients with a history of IE, a mechanical or biologic prosthetic valve, or a surgically constructed systemic or pulmonary shunt or conduit have the highest risk of developing IE during their lifetime. In addition, these same patients have the highest rates of morbidity and mortality if IE does occur. Recommended regimens for antibiotic prophylaxis remain based on administration of amoxicillin or ampicillin in a single dose administered 30 to 60 minutes before the scheduled procedure in patients with no allergy to penicillins. All patients at risk should also maintain good general and oral hygiene. Prevention of health care–associated IE should also be targeted through prevention of health care–associated bacteremias and antibiotic prophylaxis before the implantation of cardiac implantable electronic devices and prosthetic cardiac valves. Prevention of Staphylococcus aureus IE has become a priority; in the future this might be achieved with a vaccine, and candidate S. aureus vaccines are currently being evaluated in humans. Nonantibiotic approaches, based on antiplatelet or antithrombin agents or antibiofilm agents, may also be promising.