Public Health & Preventive_Infective Endocarditis (IE) Prophylaxis

Question 1

What is the theoretical basis for IE prophylaxis?

Answer 1

• Transient bacteremia (especially Streptococcus viridans ) is common after invasive procedures.

Question 2

Patients at highest risk of Infective Endocarditis

Answer 2

• Prosthetic heart valves
• prior history of IE
• unrepaired cyanotic congenital heart disease
• completely repaired congenital heart defects with prosthetic material (during the first 6 months after the procedure)
• repaired congenital heart disease with residual defects
• cardiac transplantation recipients who develop cardiac valvulopathy

Question 3

Which patients should receive prophylaxis?

Answer 3

Only patients at the highest risk undergoing high-risk procedures

Question 4

which common valvular lesions no longer require antimicrobial prophylaxis?

Answer 4

• Bicuspid aortic valve
• aortic/mitral valve disease

Question 5

What high-risk procedures are most likely to result in transient bacteremia?

Answer 5

• All dental procedures involving manipulation of either gingival tissue or the periapical region of teeth or perforation of the oral mucosa
• procedures of the respiratory tract involving incision of the respiratory mucosas
• procedures in patients with ongoing gastrointestinal (GI) or genitourinary (GU) infections
• procedures on infected skin or musculoskeletal tissue
• surgery to place prosthetic heart valves or prosthetic intravascular or intracardiac materials

Question 6

What is the recommended IE prophylaxis for dental procedures in patients at the highest risk?

Answer 6

• Amoxicillin 2 g, 1 hour prior to the procedure