Document Detail

New British and American guidelines for the antibiotic prophylaxis of infective endocarditis: do the changes make sense? A critical review.
MedLine Citation:
PMID:  18317045     Owner:  NLM     Status:  MEDLINE    
PURPOSE OF REVIEW: The British Society for Antimicrobial Chemotherapy and the American Heart Association have radically revised their guidelines for the antibiotic prophylaxis of endocarditis. This review discusses the evidence behind the most controversial changes and considers possible future developments. RECENT FINDINGS: The new guidelines emphasize good oral hygiene for preventing viridans streptococcal endocarditis. Antibiotic prophylaxis for dental procedures is only recommended for patients with the highest-risk cardiac conditions. American Heart Association guidelines no longer recommend prophylaxis for urological and gastrointestinal procedures. SUMMARY: While only up to 6% of endocarditis cases may be prevented by antibiotic prophylaxis there is controversy as to what to recommend for the individual cardiac patient undergoing a given procedure. The new guidelines about dental prophylaxis are based on epidemiological studies that failed to include sufficient subjects undergoing specific interventions. When considering viridans streptococcal rather than total bacteraemia rates, asserting that the prevalence of bacteraemia after invasive dental procedures is similar to that after toothbrushing may be incorrect. The British Society for Antimicrobial Chemotherapy report probably overestimates the risk of fatal anaphylaxis after an oral dose of amoxicillin. In contrast, the American Heart Association guidelines comment on the absence of any reports of fatal anaphylaxis associated with the antibiotic prophylaxis of endocarditis.
David Shanson
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in infectious diseases     Volume:  21     ISSN:  0951-7375     ISO Abbreviation:  Curr. Opin. Infect. Dis.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-04     Completed Date:  2008-07-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8809878     Medline TA:  Curr Opin Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  191-9     Citation Subset:  IM    
Department of Medical Microbiology, Great Ormond Street Hospital for Children, London, UK.
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MeSH Terms
Anaphylaxis / chemically induced
Antibiotic Prophylaxis* / adverse effects,  methods
Dental Care / adverse effects
Endocarditis, Bacterial / epidemiology,  prevention & control*
Evidence-Based Medicine
Practice Guidelines as Topic*
Societies, Medical
Tooth Extraction / adverse effects
United States

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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