Endocarditis prophylaxis is only recommended in the situations detailed below, as antibiotic prophylaxis may only be effective at preventing a very small number of endocarditis cases. Infective endocarditis is far more likely to be caused by frequent exposure to random bacteraemias rather than bacteraemias caused by dental, GI tract or GU tract procedures. The risk of antibiotic-related adverse events exceeds the benefit, if any, from antibiotic prophylaxis. These recommendations are taken from the European Society of Cardiology (ESC) Guidelines on the Prevention, Diagnosis and Treatment of Infective Endocarditis, 2015.
Maintenance of optimal oral health and hygiene and regular dental review are important in reducing the risk of endocarditis from dental procedures.
Cardiac conditions that require endocarditis prophylaxis
- Prosthetic cardiac valve, including a transcatheter valve or prosthetic material used for cardiac valve repair.
- Previous infective endocarditis
- Patients with congenital heart disease
The following forms of Congenital Heart Disease (CHD):
- Any type of cyanotic heart disease
- Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or
catheter intervention, during the first 6 months after the procedure or lifelong if residual shunt or valvular regurgitation remains
- Repaired CHD with residual defects at or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialisation)
Endocarditis prophylaxis IS recommended in patients with the above cardiac conditions, for all dental procedures that involve:
- manipulation of gingival tissue or the peri-apical region of teeth, or
- perforation of oral mucosa including scaling and root canal procedures.
Dental Procedures in Adults and Children
Endocarditis prophylaxis is NOT recommended for the following procedures:
- Routine anaesthetic injections through non-infected tissue
- taking dental radiographs
- placement of removable prosthodontic or orthodontic appliances
- adjustment of orthodontic appliances
- placement of orthodontic brackets
- shedding of deciduous teeth
- bleeding from trauma to the lips or oral mucosa which also includes treatment of superficial caries, removal of sutures etc.
Consult patient’s Cardiologist to confirm decision on prophylaxis. Discuss the risk of endocarditis with the patient. Explain the benefits and risks of antimicrobial prophylaxis. Record subsequent decision in patient’s notes.
Visit HPSC Information Leaflets pages for the General Public, (MRSA, CRE, etc)
- Penicillin allergy – tips on prescribing in penicillin allergy
- Renal impairment dosing table
- Drug interactions table. Extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.
- Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).
Reviewed Feb 2021