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Moderate risk patients

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Moderate risk patients

The recommendations regarding antibiotic prophylaxis in moderate risk patients undergoing ‘at-risk’ dental procedures (see 'At-risk dental procedures), adopted from the ESC guideline, are shown below. 

Note that the 2023 ESC guideline19 refers to this patient group as being at intermediate risk of infective endocarditis.

ESC recommendations regarding antibiotic prophylaxis in moderate risk patients19 

Antibiotic prophylaxis against infective endocarditis is not recommended in:

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

While antibiotic prophylaxis is not recommended in this moderate risk group, the ESC guideline states that this may be considered on an individual basis.19 Specific individual circumstances where this may be appropriate include the presence of complex cardiac risk factors or comorbidities, such as diabetes or immune suppression.31

Accordingly, a moderate risk patient’s cardiac team may recommend antibiotic prophylaxis prior to ‘at-risk’ dental procedures. In this situation, the patient should be treated as if they are in the high risk group.

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