Prevention of infective endocarditis: Guidelines from the American Heart Association

Walter Wilson, Kathryn A. Taubert, Michael Gewitz, Peter B. Lockhart, Larry M. Baddour, Matthew Levison, Ann Bolger, Christopher H. Cabell, Masato Takahashi, Robert S. Baltimore, Jane W. Newburger, Brian L. Strom, Lloyd Y. Tani, Michael Gerber, Robert O. Bonow, Thomas Pallasch, Stanford T. Shulman, Anne H. Rowley, Jane C. Burns, Patricia FerrieriTimothy Gardner, David Goff, David T. Durack

Research output: Contribution to journalArticlepeer-review

229 Scopus citations


Background. The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective endocarditis, which were last published in 1997. Methods and Results. A writing group appointed by the AHA for their expertise in prevention and treatment of infective endocarditis (IE) with liaison members representing the American Dental Association, the Infectious Diseases Society of America and the American Academy of Pediatrics. The writing group reviewed input from national and internationalexperts on IE. The recommendations in this document reflect analyses of relevant literature regarding procedurerelated bacteremia and IE; in vitro susceptibility data of the most common microorganisms, which cause IE; results of prophylactic studies in animal models of experimental endocarditis; and retrospective and prospective studies of prevention of IE. MEDLINE database searches from 1950 through 2006 were done for English language articles using the following search terms: endocarditis, infective endocarditis, prophylaxis, prevention, antibiotic, antimicrobial, pathogens, organisms, dental, gastrointestinal, genitourinary, streptococcus, enterococcus, staphylococcus, respiratory, dental surgery, pathogenesis, vaccine, immunization and bacteremia. The reference lists of the identified articles were also searched. The writing group also searched the AHA online library. The American College of Cardiology/AHA classification of recommendations and levels of evidence for practice guidelines were used. The article subsequently was reviewed by outside experts not affiliated with the writing group and by the AHA Science Advisory and Coordinating Committee. Conclusions. The major changes in the updated recommendations include the following. (1) The committee concluded that only an extremely small number of cases of IE might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100 percent effective. (2) IE prophylaxis for dental procedures should be recommended only for patientswith underlying cardiac conditions associated with the highest risk of adverse outcome from IE. (3) For patients with these underlying cardiac conditions, prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. (4) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of IE. (5) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure. These changes are intended to define more clearly when IE prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations.

Original languageEnglish (US)
Pages (from-to)739-745
Number of pages7
JournalJournal of the American Dental Association
Issue number6
StatePublished - Jun 2007


  • AHA scientific statements
  • Antibiotic prophylaxis
  • Cardiovascular disease
  • Endocarditis
  • Prevention


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