Antimicrobial Prophylaxis to Prevent Endocarditis: What Has Changed?

The American Heart Association (AHA) radically changed the recommendations regarding endocarditis prophylaxis, if patients undergo dental work. For the vast majority of patients previously considered to be at significant risk for bacterial endocarditis (especially patients with degenerative and rheumatic heart disease), routine endocarditis prophylaxis is not longer recommended from a cost-benefit-risk standpoint. Only patient populations with a very high lifetime risk for bacterial endocarditis or an expected worse outcome (patients with prosthetic heart valves, conservatively treated endocarditis, and certain groups with congenital heart disease) are judged candidates for endocarditis prophylaxis. In 2007, a German position paper (S2 guideline) comments the AHA recommendations. This position paper allows a more individual approach, if treating physician and patient agree upon the benefit of endocarditis prophylaxis in the individual case.