ESC and AHA guidelines

European Society of Cardiology and American Heart Association guidelines

Current guidelines from two other professional organisations also limit the extent of antibiotic prophylaxis against infective endocarditis (IE). However, these guidelines provide more information about situations where it may be appropriate to prescribe.

European Society of Cardiology (ESC)

The 2023 ESC Guidelines for the Management of Infective Endocarditis¹⁹ states:

‘Antibiotic prophylaxis is recommended in patients at high risk of IE undergoing at-risk dental procedures and is not currently recommended in other situations.’ 

This recommendation is based on data derived from large non-randomised studies.

American Heart Association (AHA)

The most recent (2021) AHA scientific statement Prevention of Viridans Group Streptococcal (VGS) Infective Endocarditis,²³ states:

‘Antibiotic prophylaxis for a dental procedure that involves manipulation of gingival tissues, periapical region of teeth, or perforation of the oral mucosa is suggested only for patients with the highest risk of adverse outcome from VGS IE.’ 

This recommendation is based on data derived from non-randomised studies.

Although both of these guidelines acknowledge that the evidence supporting antibiotic prophylaxis is low certainty and that there is a risk of serious adverse events, each states that the rationale for recommending prophylaxis for high risk individuals is that these patients are likely to have worse outcomes from an episode of IE.

For example, the mortality rate of patients who have had a previous episode of IE, and the risk and severity of associated complications, is greater than that of patients who have not previously had IE.²³ Patients with prosthetic valves who develop IE also have an increased risk of mortality, morbidity and complications compared to IE patients who have not had a prosthetic valve replacement.