Purpose: Infective endocarditis (IE) in high-risk patients is a potentially severe complication which justifies the admin- istration of antibiotics before invasive dental treatment. This literature review presents the current guidelines for anti- biotic prophylaxis and discusses the controversial aspects related to the antibiotic administration for prevention of IE.
Results: According to the guidelines of the American Heart Association, individuals who are at risk to develop IE follow- ing an invasive dental procedure still benefit from antibiotic prophylaxis. In contrast, the guidelines of the National In- stitute for Health and Clinical Excellence in England and Wales have recommended that prophylactic antibiotic treat- ment should no longer be performed in any at-risk patient. Bacteraemia following daily routines such as eating and toothbrushing may be a greater risk factor for the development of IE than the transient bacteraemia that follows an invasive dental procedure. However, a single administration of a penicillin derivate 30 to 60 minutes pre-operatively still represents the main prophylactic strategy to prevent bacteraemia.
Conclusions: Presently, there is not enough evidence that supports and defines the administration of antibiotics to prevent IE. The authors suggest performing a risk-benefit evaluation in light of the available guidelines before a deci- sion is made about administration.
