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High risk patients

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High risk patients

The recommendations for antibiotic prophylaxis in high risk patients undergoing ‘at-risk’ dental procedures (see ‘At-risk’ dental procedures), adopted from the European Society of Cardiology (ESC) guideline,19 are shown below.

As well as being at high risk of IE, these patients are also considered to be at particularly high risk of developing serious and potentially life-threatening complications.19,23 

ESC recommendations regarding antibiotic prophylaxis in high risk patients19 

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

(Class I recommendations; level of evidence *B or C)

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)

(Class IIa recommendation; level of evidence C)

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

(Class IIb recommendation; level of evidence C)

Note that the wording of each recommendation reflects the level of evidence/consensus and the class of recommendation. 

The Class I recommendations from the ESC guideline are supported by evidence predominantly from observational studies. There is less evidence to support the Class IIa and IIb recommendations. However, due to the increased morbidity and mortality associated with an episode of IE in these groups, these patients are also considered to be at high risk.

See ESC recommendations for high risk patients for more details of the ESC recommendations.

For further explanation of the cardiac terms used in this implementation advice, see Glossary of cardiac terms.