Prophylaxis for infective endocarditis - an endless story with a colorful past, an uncertain presence and unclear future
Abstract
Opinions on the prevention of infective endocarditis (IE) have significantly changed in recent years. A gradual departure from antibiotic prophylaxis can be observed, both in terms of the spectrum of procedures and the profile of individuals in whom it is indicated.
The extreme case is the rejection of all antibiotic prophylaxis in all patients and for all procedures in some countries. Concise conclusions are primarily provided by European recommendations.
Patients at the highest risk are currently recommended for prophylaxis; this in particular concerns valvular prostheses, some complex congenital heart defects, sewn palliative shunts, conduits or prostheses, and conditions after IE. Prophylaxis should be administered before dental procedures involving manipulation of the gums and before implantation of pacemakers and similar devices (Implantable Cardioverter Defibrillator - ICD).
Prophylaxis is administered with 2 grams of amoxicillin or ampicillin given within 30-60 min before the procedure, in case of penicillin allergy clindamycin is recommended, before implantation of pacemakers or ICD are given first-generation cephalosporins or vancomycin. Proper oral hygiene and regular dental checkups should be the basic rule for at-risk patients as well as strictly sterile performance of all risk involving interventions.