Table 3

 Summary of current recommendations for prophylaxis of IE

Procedural riskGroup A: high riskGroup B: lower risk
*Factors determining whether antibiotic prophylaxis is prescribed when deemed optional. For: age >65 years; cardiac, renal, respiratory, and hepatic insufficiency; diabetes mellitus; acquired, constitutional, or therapeutic immunosuppression; oral or dental condition; inadequate oral or dental hygiene; important bleeding (intensity, duration); technically difficult or prolonged procedure; patient’s opinion after receiving information. Against: allergy to several antibiotics; patient’s opinion after receiving information.
†Diagnostic and therapeutic interventions likely to produce bacteraemia: bronchoscopy (rigid instrument), cystoscopy during urinary tract infection, biopsy of urinary tract or prostate, tonsillectomy and adenoidectomy, oesophageal dilatation or sclerotherapy, instrumentation of obstructed biliary tract, transurethral resection of prostate, lithotripsy, and gynaecological procedures in the presence of infection.
Cardiac conditions conferring risk of IE
Valve prosthesis (mechanical, homograft, or bioprosthesisValvar disease; aortic regurgitation, mitral regurgitation, mitral stenosis, aortic stenosis
Cyanotic congenital heart disease and pulmonary-systemic shunts History of IEMitral valve prolapse with mitral regurgitation or valve thickening Bicuspid aortic valve Non-cyanotic congenital heart disease
Obstructive hypertrophic cardiomyopathy (with murmur)
Indications for antibiotic prophylaxis: oral or dental procedures
HighRecommendedOptional*
LowNot recommendedNot recommended
Indications for antibiotic prophylaxis: non-oral or dental procedures†
Very highRecommendedRecommended
HighRecommendedOptional*
LowOptional*Not recommended
NegligibleNot recommendedNot recommended