Recommendations for endocarditis prophylaxis were amended by the American Heart Association in 2007 and supplemented by the European Society of Cardiology in 2009/2015.
In which patients should endocarditis prophylaxis be given:
- Patients with prosthetic heart valves/reconstructed heart valves with alloprosthetic material.
- Patients with condition after endocarditis
- Patients with congenital heart defects
- Uncorrected cyanotic heart defects (group of heart defects in which the patient appears blue (cyanosis) as deoxygenated blood bypasses the lungs), residuals, palliative shunts (short circuit connection with fluid crossing between normally separated vessels)
- Up to six months after surgical/interventional correction, if foreign material was introduced
- Residual defects after surgical/interventional correction with insertion of prosthetic material.
No prophylaxis is needed for patients with native valve disease without valve replacement.
It is still important to maintain good oral hygiene.
In which procedures should be endocarditis prophylaxis:
- Dental procedures with injury to the gums or oral mucosa.
- Dental procedures with intraligamentary anesthesia – form of analgesia (elimination of pain) in which a small amount (about 0.2 ml) of an anesthetic (numbing agent) is inserted between the tooth and the jawbone with a very fine hypodermic needle
- Procedures on the upper respiratory tract with mucosal injury, such as tonsillectomy (palatine tonsillectomy) or adenotomy (pharyngeal tonsillectomy)
Endocarditis prophylaxis is not necessary for caries therapy, root canal therapy, or application of local anesthetics to uninfected gums.
Endocarditis prophylaxis is not necessary for the following procedures:
- Skin/soft tissue procedures.
- Procedures on the gastrointestinal tract, including gastroscopy (gastroscopy) or colonoscopy with biopsy (tissue sampling)
- Interventions on the genitourinary tract (urinary and genital tract).
Which antibiotics are used for endocarditis prophylaxis:
| Drug group | Active ingredient | Dosage | Special features |
| Aminopenicillins | Amoxicillin | 2 g | |
| Ampicillin | 2 g | ||
| Lincosamide | Clindamycin | 600 mg | For penicillin allergy |
| Vancomycin | 1 g | For MRSA colonization |
Antibiosis (antibiotic treatment) should be administered 60-90 minutes before the procedure.
