Prevention of bacterial endocarditis. Recommendations by the American Heart Association

A. S. Dajani, K. A. Taubert, W. Wilson, A. F. Bolger, A. Bayer, P. Ferrieri, M. H. Gewitz, S. T. Shulman, S. Nouri, J. W. Newburger, C. Hutto, T. J. Pallasch, T. W. Gage, M. E. Levison, G. Peter and G. Zuccaro Jr
American Heart Association, Dallas, Tex 75231, USA.

OBJECTIVE: To update recommendations issued by the American Heart Association last published in 1990 for the prevention of bacterial endocarditis in individuals at risk for this disease. PARTICIPANTS: An ad hoc writing group appointed by the American Heart Association for their expertise in endocarditis and treatment with liaison members representing the American Dental Association, the Infectious Diseases Society of America, the American Academy of Pediatrics, and the American Society for Gastrointestinal Endoscopy. EVIDENCE: The recommendations in this article reflect analyses of relevant literature regarding procedure-related endocarditis, in vitro susceptibility data of pathogens causing endocarditis, results of prophylactic studies in animal models of endocarditis, and retrospective analyses of human endocarditis cases in terms of antibiotic prophylaxis usage patterns and apparent prophylaxis failures. MEDLINE database searches from 1936 through 1996 were done using the root words endocarditis, bacteremia, and antibiotic prophylaxis. Recommendations in this document fall into evidence level III of the US Preventive Services Task Force categories of evidence. CONSENSUS PROCESS: The recommendations were formulated by the writing group after specific therapeutic regimens were discussed. The consensus statement was subsequently reviewed by outside experts not affiliated with the writing group and by the Science Advisory and Coordinating Committee of the American Heart Association. These guidelines are meant to aid practitioners but are not intended as the standard of care or as a substitute for clinical judgment. CONCLUSIONS: Major changes in the updated recommendations include the following: (1) emphasis that most cases of endocarditis are not attributable to an invasive procedure; (2) cardiac conditions are stratified into high-, moderate-, and negligible-risk categories based on potential outcome if endocarditis develops; (3) procedures that may cause bacteremia and for which prophylaxis is recommended are more clearly specified; (4) an algorithm was developed to more clearly define when prophylaxis is recommended for patients with mitral valve prolapse; (5) for oral or dental procedures the initial amoxicillin dose is reduced to 2 g, a follow-up antibiotic dose is no longer recommended, erythromycin is no longer recommended for penicillin-allergic individuals, but clindamycin and other alternatives are offered; and (6) for gastrointestinal or genitourinary procedures, the prophylactic regimens have been simplified. These changes were instituted to more clearly define when prophylaxis is or is not recommended, improve practitioner and patient compliance, reduce cost and potential gastrointestinal adverse effects, and approach more uniform worldwide recommendations.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Transesophageal echocardiography-related complications: [Complications associees a l'echocardiographie transoesophagienne]
Cote and Denault
Canadian J. Anesthesia 2008;55:622-647.
ABSTRACT | FULL TEXT  

The new American Heart Association guidelines on the prevention of infective endocarditis: culmination of a long process of thought
Duval et al.
Heart 2008;94:715-716.
FULL TEXT  

Infective endocarditis prophylaxis before dental procedures: New guidelines spark controversy
KIM and KEYS
Cleveland Clinic Journal of Medicine 2008;75:89-92.
FULL TEXT  

Endocarditis Prophylaxis: Do We Have It Right This Time?
Danford
AAP Grand Rounds 2008;19:13-14.
FULL TEXT  

Occurrence of staphylococci in the oral cavities of healthy adults and nasal oral trafficking of the bacteria
Ohara-Nemoto et al.
J Med Microbiol 2008;57:95-99.
ABSTRACT | FULL TEXT  

Prevention of infective endocarditis: Guidelines from the American Heart Association: A guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group
Wilson et al.
Journal of the American Dental Association 2008;139:3S-24S.
ABSTRACT | FULL TEXT  

Efficacy of Antibiotic Prophylactic Regimens for the Prevention of Bacterial Endocarditis of Oral Origin
Carmona et al.
J. Dent. Res. 2007;86:1142-1159.
ABSTRACT | FULL TEXT  

Efficacy of Antibiotic Prophylactic Regimens for the Prevention of Bacterial Endocarditis of Oral Origin
Carmona et al.
FAKE JDR 2007;86:1142-1159.
ABSTRACT | FULL TEXT  

Prevention of Infective Endocarditis: Guidelines From the American Heart Association: A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group
Wilson et al.
Circulation 2007;116:1736-1754.
ABSTRACT | FULL TEXT  

Clinical Reminders Attached to Echocardiography Reports of Patients With Reduced Left Ventricular Ejection Fraction Increase Use of {beta}-Blockers: A Randomized Trial
Heidenreich et al.
Circulation 2007;115:2829-2834.
ABSTRACT | FULL TEXT  

Prevention of infective endocarditis: Guidelines from the American Heart Association: A guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group
Wilson et al.
Journal of the American Dental Association 2007;138:739-760.
ABSTRACT | FULL TEXT  

Epidemiology and Clinical Outcomes of Infective Endocarditis in Hemodialysis Patients
Kamalakannan et al.
Ann. Thorac. Surg. 2007;83:2081-2086.
ABSTRACT | FULL TEXT  

Pregnancy in women with valvular heart disease
Stout and Otto
Heart 2007;93:552-558.
ABSTRACT | FULL TEXT  

Definition, clinical profile, microbiological spectrum, and prognostic factors of early-onset prosthetic valve endocarditis
Lopez et al.
Eur Heart J 2007;28:760-765.
ABSTRACT | FULL TEXT  

The impact of oral disease and nonsurgical treatment on bacteremia in children
Brennan et al.
Journal of the American Dental Association 2007;138:80-85.
ABSTRACT | FULL TEXT  

Infective Endocarditis Associated with Sjogren's Syndrome
Sughimoto et al.
Asian Cardiovasc. Thorac. Ann. 2006;14:e115-e117.
ABSTRACT | FULL TEXT  

Infective endocarditis complicating hypertrophic obstructive cardiomyopathy
Louahabi et al.
Eur J Echocardiogr 2006;7:468-470.
ABSTRACT | FULL TEXT  

Anesthetic Management of a Young Adult with Complex Congenital Heart Disease and Bronchopleural Fistula for Rigid Bronchoscopy
Bailey et al.
Anesth. Analg. 2006;103:1432-1435.
ABSTRACT | FULL TEXT  

Comparative Efficacies of Amoxicillin, Clindamycin, and Moxifloxacin in Prevention of Bacteremia following Dental Extractions.
Diz Dios et al.
Antimicrob. Agents Chemother. 2006;50:2996-3002.
ABSTRACT | FULL TEXT  

Peritoneal dialysis: a primary care perspective.
Saxena and West
J Am Board Fam Med 2006;19:380-389.
ABSTRACT | FULL TEXT  

The changing face of infective endocarditis
Prendergast
Heart 2006;92:879-885.
ABSTRACT | FULL TEXT  

Drug therapy during labor and delivery, part 1.
Briggs and Wan
Am J Health Syst Pharm 2006;63:1038-1047.
ABSTRACT | FULL TEXT  

Postural orthostatic tachycardia syndrome: Dental treatment considerations
Brooks and Francis
Journal of the American Dental Association 2006;137:488-493.
ABSTRACT | FULL TEXT  

The importance of echocardiography in physicians' support of endocarditis prophylaxis.
Singh et al.
Arch Intern Med 2006;166:549-553.
ABSTRACT | FULL TEXT  

Prevention of Bacterial Endocarditis
Red Book 2006;2006:828-828.
FULL TEXT  

Recommendations for the management of patients after heart valve surgery
Butchart et al.
Eur Heart J 2005;26:2463-2471.
ABSTRACT | FULL TEXT  

Infective Endocarditis
Hoyer and Silberbach
Pediatr. Rev. 2005;26:394-400.
FULL TEXT  

Preoperative and Perioperative Care for Patients With Suspected or Established Aortic Stenosis Facing Noncardiac Surgery
Christ et al.
Chest 2005;128:2944-2953.
ABSTRACT | FULL TEXT  

Valvular Heart Disease and Pregnancy: Part I: Native Valves
Elkayam and Bitar
J Am Coll Cardiol 2005;46:223-230.
ABSTRACT | FULL TEXT  

Is Antibiotic Prophylaxis for Bacterial Endocarditis Cost-Effective?
Agha et al.
Med Decis Making 2005;25:308-320.
ABSTRACT  

Infective endocarditis in Europe: lessons from the Euro heart survey
Tornos et al.
Heart 2005;91:571-575.
ABSTRACT | FULL TEXT  

Infective Endocarditis Caused by Granulicatella elegans Originating in the Oral Cavity
Ohara-Nemoto et al.
J. Clin. Microbiol. 2005;43:1405-1407.
ABSTRACT | FULL TEXT  

The patient with a heart murmur: Evaluation, assessment and dental considerations
LESSARD et al.
Journal of the American Dental Association 2005;136:347-356.
ABSTRACT | FULL TEXT  

Delayed Diagnosis of Penicillin-resistant Streptococcus mitis Endocarditis Following Single-Dose Amoxicillin Prophylaxis in a Child
Kennedy et al.
CLIN PEDIATR 2004;43:773-776.
 

Making Cystourethrography Less Stressful
Wood
AAP Grand Rounds 2004;11:69-70.
FULL TEXT  

Cardiac Disease in Pregnancy
Arafeh and El-Sayed
NeoReviews 2004;5:e232-e239.
FULL TEXT  

Prophylactic Use of Vancomycin in Adult Cardiology and Cardiac Surgery
Movahed et al.
J CARDIOVASC PHARMACOL THER 2004;9:13-20.
ABSTRACT  

Guidelines on Prevention, Diagnosis and Treatment of Infective Endocarditis Executive Summary: The Task Force on Infective Endocarditis of the European Society of Cardiology
Task Force Members et al.
Eur Heart J 2004;25:267-276.
FULL TEXT  

Antibiotic prophylaxis, body piercing and infective endocarditis
Millar and Moore
J Antimicrob Chemother 2004;53:123-126.
ABSTRACT | FULL TEXT  

Visual Diagnosis: A 14-year-old Male Who Has Fever and Rash
Stauffer et al.
Pediatr. Rev. 2003;24:424-429.
FULL TEXT  

Nonvalvular Cardiovascular Device-Related Infections
Baddour et al.
Circulation 2003;108:2015-2031.
FULL TEXT  

The sloABCR Operon of Streptococcus mutans Encodes an Mn and Fe Transport System Required for Endocarditis Virulence and Its Mn-Dependent Repressor
Paik et al.
J. Bacteriol. 2003;185:5967-5975.
ABSTRACT | FULL TEXT  

Asymptomatic cardiac disease following mediastinal irradiation
Heidenreich et al.
J Am Coll Cardiol 2003;42:743-749.
ABSTRACT | FULL TEXT  

Management of Patients Undergoing Percutaneous Coronary Revascularization
Levine et al.
ANN INTERN MED 2003;139:123-136.
ABSTRACT | FULL TEXT  

Valvular Heart Disease in Pregnancy
Reimold and Rutherford
NEJM 2003;349:52-59.
FULL TEXT  

Antibiotic prophylaxis for dental patients with total joint replacements
AMERICAN DENTAL ASSOCIATION and AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS
Journal of the American Dental Association 2003;134:895-898.
ABSTRACT | FULL TEXT  

Bacterial Endocarditis: The Disease, Treatment, and Prevention
Cabell et al.
Circulation 2003;107 :e185-e187.
FULL TEXT  

Managing the care of patients infected with bloodborne diseases
DePAOLA
Journal of the American Dental Association 2003;134:350-358.
ABSTRACT | FULL TEXT  

A Prospective Evaluation of the Incidence of Complications Associated With Mohs Micrographic Surgery
Cook and Perone
Arch Dermatol 2003;139:143-152.
ABSTRACT | FULL TEXT  

Prevention of Bacterial Endocarditis
Red Book 2003;2003:778-778.
FULL TEXT  

Comparison of Lysis Filtration and an Automated Blood Culture System (BACTEC) for Detection, Quantification, and Identification of Odontogenic Bacteremia in Children
Lucas et al.
J. Clin. Microbiol. 2002;40:3416-3420.
ABSTRACT | FULL TEXT  

Oral care for patients with cardiovascular disease and stroke
ROSE et al.
Journal of the American Dental Association 2002;133:37S-44S.
ABSTRACT | FULL TEXT  

Unique Features of Infective Endocarditis in Childhood
Ferrieri et al.
Pediatrics 2002;109:931-943.
FULL TEXT  

Unique Features of Infective Endocarditis in Childhood
Ferrieri et al.
Circulation 2002;105:2115-2126.
FULL TEXT  

Prophylactic use of antibiotics and immunisations in patients with SLE
Gilliland and Tsokos
Ann Rheum Dis 2002;61:191-192.
FULL TEXT  

Echocardiography in Healthy Children
Brookfield; et al.
Pediatrics 2001;107:1237-1237.
FULL TEXT  

Longitudinal surveillance of antibiotic use in the hospital
Raveh et al.
QJM 2001;94:141-152.
ABSTRACT | FULL TEXT  

Heart murmurs: are older male dental patients aware of their existence?
RANDALL et al.
Journal of the American Dental Association 2001;132:171-176.
ABSTRACT | FULL TEXT  

Dental procedures in children with severe congenital heart disease: a theoretical analysis of prophylaxis and non-prophylaxis procedures
Al-Karaawi et al.
Heart 2001;85:66-68.
ABSTRACT | FULL TEXT  

Risk Factors for Infective Endocarditis : Oral Hygiene and Nondental Exposures
Strom et al.
Circulation 2000;102:2842-2848.
ABSTRACT | FULL TEXT  

Thrombin-Induced Platelet Microbicidal Protein Susceptibility Phenotype Influences the Outcome of Oxacillin Prophylaxis and Therapy of Experimental Staphylococcus aureus Endocarditis
Dhawan et al.
Antimicrob. Agents Chemother. 2000;44:3206-3209.
ABSTRACT | FULL TEXT  

Relationship of Dental and Oral Pathology to Systemic Illness
Slavkin and Baum
JAMA 2000;284:1215-1217.
FULL TEXT  

Physicians' Recommendations to Patients for Use of Antibiotic Prophylaxis to Prevent Endocarditis
Seto et al.
JAMA 2000;284:68-71.
ABSTRACT | FULL TEXT  

Single-Oral-Dose Azithromycin Prophylaxis against Experimental Streptococcal or Staphylococcal Aortic Valve Endocarditis
Tsitsika et al.
Antimicrob. Agents Chemother. 2000;44:1754-1756.
ABSTRACT | FULL TEXT  

SUBACUTE BACTERIAL ENDOCARDITIS: CONSIDERATIONS FOR THE PEDIATRIC PATIENT
SOXMAN
Journal of the American Dental Association 2000;131:668-669.
FULL TEXT  

Simple and Safe Method to Prepare Patients With Prosthetic Heart Valves for Surgical Dental Procedures
Russo et al.
CLIN APPL THROMB HEMOST 2000;6:90-93.
ABSTRACT  

Echocardiographic Diagnosis of Heart Disease in Apparently Healthy Adolescents
Steinberger et al.
Pediatrics 2000;105:815-818.
ABSTRACT | FULL TEXT  

ANTIBIOTIC PROPHYLAXIS IN DENTISTRY: A REVIEW AND PRACTICE RECOMMENDATIONS
TONG and ROTHWELL
Journal of the American Dental Association 2000;131:366-374.
ABSTRACT | FULL TEXT  

Congenital Heart Disease in Adults- First of Two Parts
Brickner et al.
NEJM 2000;342:256-263.
FULL TEXT  

Rigid Tracheobronchoscopy-Induced Bacteremia in the Pediatric Population
Ansley et al.
Arch Otolaryngol Head Neck Surg 1999;125:774-776.
ABSTRACT | FULL TEXT  

Pregnancy among women with congenitally corrected transposition of great arteries
Connolly et al.
J Am Coll Cardiol 1999;33:1692-1695.
ABSTRACT | FULL TEXT  

Infective Endocarditis in Hypertrophic Cardiomyopathy : Prevalence, Incidence, and Indications for Antibiotic Prophylaxis
Spirito et al.
Circulation 1999;99:2132-2137.
ABSTRACT | FULL TEXT  

Antimicrobial prophylaxis
Smith and Finn
Arch. Dis. Child. 1999;80:388-392.
FULL TEXT  

Noncardiac surgery in Eisenmenger syndrome
Ammash et al.
J Am Coll Cardiol 1999;33:222-227.
ABSTRACT | FULL TEXT  

Diagnosis and Management of Infective Endocarditis and Its Complications
Bayer et al.
Circulation 1998;98:2936-2948.
FULL TEXT  

Endocarditis Prophylaxis for Transrectal Prostatic Biopsy
Basaran et al.
JAMA 1998;280:1908-1908.
FULL TEXT  

Circumcision and Endocarditis Prophylaxis
Storms et al.
Arch Pediatr Adolesc Med 1998;152:1038-1039.
FULL TEXT  

Appetite Suppressants and Valvular Heart Disease
Devereux
NEJM 1998;339:765-767.
FULL TEXT  

Dental Surgery in Anticoagulated Patients
Wahl
Arch Intern Med 1998;158:1610-1616.
ABSTRACT | FULL TEXT  

Circumcision and Endocarditis Prophylaxis
Schlesinger and Urbach
Arch Pediatr Adolesc Med 1998;152:412-412.
FULL TEXT  

Preoperative Cardiac Evaluation for Elective Noncardiac Surgery
Potyk and Raudaskoski
Arch Fam Med 1998;7:164-173.
ABSTRACT | FULL TEXT  

Thirty-Year Incidence of Infective Endocarditis After Surgery for Congenital Heart Defect
Morris et al.
JAMA 1998;279:599-603.
ABSTRACT | FULL TEXT  

Pediatric Therapeutic Cardiac Catheterization : A Statement for Healthcare Professionals From the Council on Cardiovascular Disease in the Young, American Heart Association
Allen et al.
Circulation 1998;97:609-625.
FULL TEXT