Antimicrobial prophylaxis for bacterial endocarditis
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
- Vivian H Chu, MD, MHS
Vivian H Chu, MD, MHS
- Associate Professor of Medicine
- Duke University Medical Center
- Section Editor
- Catherine M Otto, MD
Catherine M Otto, MD
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Cardiac Evaluation; Valvular Disease
- Professor of Medicine
- University of Washington
Use of antimicrobial prophylaxis for prevention of bacterial endocarditis is based on theoretical advantage rather than data from clinical trials.
The 2007 American Heart Association (AHA) guideline for the prevention of infective endocarditis (IE)  made major revisions to the 1997 AHA guideline, the 2005 update of those guidelines published by the Medical Letter , and the 2006 American College of Cardiology (ACC)/AHA guideline on the management of valvular heart disease . Since the publication of the 2007 AHA guideline, the ACC/AHA guideline has been updated several times, most recently in the 2017 AHA/ACC focused update of the 2014 valvular heart disease guidelines [4,5]. The 2015 European Society of Cardiology (ESC) guidelines are largely in agreement with the American guidelines .
The theoretical basis and clinical approach for use of antimicrobial prophylaxis for prevention of bacterial endocarditis will be reviewed here . Issues related to the diagnosis and treatment of endocarditis are discussed separately. (See "Clinical manifestations and evaluation of adults with suspected native valve endocarditis" and "Antimicrobial therapy of native valve endocarditis".)
The pathogenesis of infective endocarditis (IE) is presumed to involve the following sequence of events :
●Formation of a small thrombus on an abnormal endothelial surface
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- Animal studies
- Human studies
- - Effect of antibiotic prophylaxis on bacteremia
- - Time-trend studies
- - Limitations of prophylaxis
- CLINICAL APPROACH
- Patients at highest risk
- Relevant procedures
- - Dental work
- - Respiratory tract
- - Genitourinary and gastrointestinal tracts
- - Vaginal or cesarean delivery
- - Skin or musculoskeletal tissue
- Patients on antibiotics
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS