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
- 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 2014 in the AHA/ACC guidelines on the management of valvular heart disease . The 2009 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 diagnosis of infective 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
- - Prophylaxis failure
- CLINICAL APPROACH
- Patients at highest risk
- Relevant procedures
- - Dental work and respiratory tract
- - Genitourinary and gastrointestinal tracts
- - Vaginal or cesarean delivery
- - Skin or musculoskeletal tissue
- Patients on antibiotics
- TRENDS IN ENDOCARDITIS INCIDENCE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS