Bacterial endocarditis prophylaxis

Current guidelines for the prevention of bacterial infective endocarditis (IE) recommend antibiotic prophylaxis for dental procedures only in patients with cardiac conditions that are associated with the highest risk for adverse outcomes from IE. These conditions include:

• Prosthetic cardiac valves
• Previous IE
• Valvulopathy in recipients of cardiac transplant
• Congenital heart disease (CHD)
  • Unrepaired cyanotic CHD
  • Repaired CHD with prosthetic material during the first 6 months after the procedure
  • Repaired CHD with residual defects

Mitral valve prolapse (MVP) is the most common underlying condition that raises the relative risk of developing IE; however, the absolute risk of developing IE in patients with MVP (with or without mitral regurgitation) is low. There is currently no evidence that the benefits of IE prophylaxis during invasive procedures (eg, dental manipulation, respiratory tract incision) outweigh the potential harm (eg, allergic reaction, antibiotic resistance) in patients with MVP, and prophylaxis is not recommended.