Executive summary

Shared decision-making

Decisions about treatment options should be made in consultation with the patient and should include discussion of the potential benefits and harms of antibiotic prophylaxis.

Refer to Shared decision-making for more information.

Recommendations for patients at high risk of infective endocarditis

Antibiotic prophylaxis against infective endocarditis is recommended in:

• patients with a previous episode of infective endocarditis
• patients with surgically implanted prosthetic valves and with any material used for surgical cardiac valve repair
• patients with transcatheter implanted aortic and pulmonary valvular prostheses 
• patients with untreated cyanotic congenital heart disease (CHD), and patients treated with surgery or transcatheter procedures with post-operative palliative shunts, conduits or other prostheses
  (Note: After surgical repair, in the absence of residual defects or valve prostheses, antibiotic prophylaxis is recommended only for the first 6 months after the procedure)
• patients with ventricular assist devices 

Antibiotic prophylaxis against infective endocarditis should be considered in patients with transcatheter mitral and tricuspid valve repair

(Note: Patients with septal defect closure devices, left atrial appendage closure devices, vascular grafts, vena cava filters, and central venous system ventriculo-atrial shunts are considered within this risk category only in the first 6 months after implantation).

Antibiotic prophylaxis against infective endocarditis may be considered in recipients of heart transplant.

Refer to Patients at risk of infective endocarditis for more information.

Recommendations for patients at moderate risk of infective endocarditis

Antibiotic prophylaxis against infective endocarditis is not recommended in:

• patients with rheumatic heart disease
• patients with non-rheumatic degenerative valve disease
• patients with congenital valve abnormalities including bicuspid aortic valve disease 
• patients with cardiovascular implanted electronic devices
• patients with hypertrophic cardiomyopathy

Antibiotic prophylaxis is not required for patients at moderate risk of infective endocarditis unless this is already specified by the patient's cardiac team (e.g. due to comorbidities). 

Refer to Patients at risk of infective endocarditis for more information.

Prevention of infective endocarditis

All patients at high risk and moderate risk of infective endocarditis should be given clear and consistent information about prevention of infective endocarditis and reducing poorer outcomes, including:

• the importance of maintaining good oral health
• symptoms that may indicate infective endocarditis and when to seek expert advice 
• the risks of undergoing invasive procedures, including non-medical procedures such as body piercing or tattooing.

Refer to Prevention of infective endocarditis for more information.

Recommendations for antibiotic prophylaxis for ‘at-risk’ dental procedures

For patients at high risk of infective endocarditis:

• offer antibiotic prophylaxis prior to extractions and oral surgery procedures. 

• consider antibiotic prophylaxis for dental procedures that involve manipulation of the gingival or periapical region of the teeth. This must involve reaching a shared decision with the patient and consideration of their oral health status.

Refer to 'At-risk’ dental procedures for more information.

Discuss the potential benefits and harms (e.g. common side effects such as nausea and diarrhoea; more rare adverse events such as hypersensitivity and anaphylaxis) of antibiotic prophylaxis to allow the patient to make an informed decision about whether prophylaxis is appropriate for their individual situation. A Patient discussion aid and a Patient information leaflet are provided.

Refer to Management of patients at increased risk of infective endocarditis and Management flowchart for further advice on the management of patients at high risk of infective endocarditis undergoing ‘at-risk’ dental procedures.