• in-hospital mortality 15-20%

• strongly associated with poor oral hygiene and gingival disease

• IE is more likely to result from daily oral hygiene activities than from specific procedures
• NICE Guidelines 2016
  • not "routinely" required
• ETC 2021 = cardiac condition + procedure
• most important
  • dental hygiene
  • timely treatment of bacterial infections
• IE Prophylaxis AHA 2007
  • IEP for dental procedures
    • only prevents an extremely small number of cases
    • reasonable in patients with cardiac conditions associated with highest risk of ADVERSE OUTCOME From IE
      • prosthetic cardiac valve
      • previous IE
      • CHD
        • unrepaired cyanotic defects, including palliative shunts and conduits
        • repaired defects with residual defects
      • CTX + cardiac valvulopathy
      • RHD in high risk patients
    • for procedures that involve manipulation of gingival tissue / periapical region of teeth / perforation of oral mucosa
    • ⬆risk bacteraemia
  • not recommended based solely on ⬆lifetime risk of IE
    • eg. rheumatic heart disease, MVP
  • GU / GIT procedure
    • not routinely recommended
    • only if cardiac AND established infection
  • Dermatological / MSk
    • only if cardiac AND those involving infected skin / muscle
  • Respiratory / ENT
    • only if cardiac AND tonsillectomy, adenoidectomy / invasive procedures to treat infection (eg. abscess)
• Regimens
  • amoxicillin 2 g PO, 60 minutes before procedure
  • cefazolin 2 g IV, 60 minutes preop

• Pre-op
• Intra-op
• Post-op

Prevention of Infective Endocarditis, AHA 2007

Prevention of IE, ETG

NICE Guidelines 2016