Antimicrobial prophylaxis for endocarditis: Emotion or science

Houman Ashrafian ¹ and Richard G Bogle ^2*

¹ Royal Brompton and Harefield NHS Trust, United Kingdom
² Imperial College London, United Kingdom

^* To whom correspondence should be addressed. E-mail: r.bogle{at}imperial.ac.uk.

Accepted 8 August 2006

Abstract

The link between dental hygiene and infective endocarditis (IE) was made in 1909 by Horder who observed that "infection is grafted upon a previously sclerosed endocardium...the source of the infecting agent, in most of the cases, is the mouth...". Accordingly, the American Heart Association, European Society of Cardiology and British Cardiac Society published guidelines on the prevention of IE. These guidelines recommended administration of antibiotics at the time of dental treatment for all patients deemed to be a high or moderate risk of IE. Recently, new guidelines have been published by the Working Party of the British Society for Antimicrobial Chemotherapy (BSAC). BSAC guidelines are important as their recommendations will be adopted by the British National Formulary and will be influential in medico-legal disputes. In contrast to previous guidelines, BSAC recommend prophylaxis in only three circumstances: previous IE, prosthetic valves and surgically constructed pulmonary shunts or conduits. This radical step to limit prophylaxis to high risk patients has been welcomed by the dental community who laud the guidelines as "a victory for science and common sense."

Keywords: Antibiotics, Dental, Endocarditis

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