Background
Medical procedures on mucous membranes lead to short-lasting bacteremia, which can cause bacterial endocarditis. Such inflammation of the inner lining of the heart, although very rare, is life-threatening with a high mortality. Patients with certain heart conditions have an increased risk of developing endocarditis. These include patients with valve replacements, endocarditis that has occurred, reconstructed heart valves, congenital vitiation, and patients after heart transplantation with new-onset damage to the heart valve. Patients at risk receive an endocarditis identification card (adults: orange, children: dark yellow) under medical care, which is available from the Swiss Heart Foundation.
Drug prophylaxis
For oral prophylaxis, a single dose of an antibiotic is taken 1 hour before the procedure. The decision to use prophylaxis and the choice of agent are based on the patient’s risk profile and age, the type of procedure, and any allergies. Intravenous administration 30 minutes before the procedure is also possible. For dental procedures, amoxicillin at a dose of 2 g p.o. is the first-line agent. In children, the dose is 50 mg/kg p.o. Cefuroxime is used for late-type penicillin allergy and clindamycin for immediate-type penicillin allergy. Note: The drug label differs from the new guidelines and recommends a dosage of 3 g of adult amoxicillin (e.g., Amoxicillin Sandoz). Prophylaxis remains highly controversial due to insufficient clinical trial data. Randomized and placebo-controlled double-blind studies could not be performed so far for various reasons and the efficacy of antibiotics has not been proven in this indication (see e.g. Oliver et al., 2008). In recent years, guidelines have been adapted internationally for this reason and are now limited to high-risk patients.