PREVENTION OF BACTERIAL-ENDOCARDITIS - RECOMMENDATIONS BY THE AMERICAN-HEART-ASSOCIATION

OBJECTIVE-To update recommendations issued by the American Heart Assoc iation last published in 1990 for the prevention of bacterial endocard itis in individuals at risk for this disease. PARTICIPANTS-An ad hoc w riting group appointed by the American Heart association for their exp ertise in endocarditis and treatment with liaison members representing the American Dental Association, the Infectious Diseases Society of A merica, the American Academy of Pediatrics and the American Society fo r Gastrointestinal Endoscopy. EVIDENCE-The recommendations in this art icle reflect analyses of relevant literature regarding procedure-relat ed endocarditis, in vitro susceptibility data of pathogens causing end ocarditis, results of prophylactic studies in animal models of endocar ditis and retrospective analyses of human endocarditis cases in terms of antibiotic prophylaxis usage patterns and apparent prophylaxis fail ures, MEDLINE database searches from 1936 through 1996 were done using root words endocarditis, bacteremia and antibiotic prophylaxis. Recom mendations in this document fall into evidence level III of the U.S. P reventive Services Task Force categories of evidence. Consensus Proces s-The recommendations were formulated by the writing group after speci fic therapeutic regimens were discussed. The consensus statement was s ubsequently reviewed by outside experts not affiliated with the writin g group and by the Science Advisory and Coordinating Committee of the American Heart Association, These guidelines are meant to aid practiti oners but are not intended as the standard of care or as a substitute for clinical judgment. CONCLUSIONS-Major changes in the updated recomm endations include the following: (1) emphasis that most cases of endoc arditis are not attributable to an invasive procedure; (2) cardiac con ditions are stratified into high-, moderate- and negligible-risk categ ories based on potential outcome if endocarditis develops; (3) procedu res that may cause bacteremia and for which prophylaxis is recommended are more clearly specified; (4) an algorithm was developed to more cl early define when prophylaxis is recommended for patients with mitral valve prolapse; (5) for oral or dental procedures the initial amoxicil lin dose is reduced to 2 g, a follow-up antibiotic dose is no longer r ecommended, erythromycin is no longer recommended for penicillin-aller gic individuals, but clindamycin and other alternatives are offered.