Antibiotic prophylaxis for infective endocarditis (Dental Guidelines)

NHS Highland Cardiology Antibiotic Prophylaxis Guideline for patients at increased risk of Infective Endocarditis

The cardiologists in NHS Highland acknowledge the poor quality evidence for the effectiveness of antibiotic prophylaxis for the prevention of infective endocarditis (IE).  In patients with the following underlying cardiac conditions, associated with the highest incidence and risk of adverse outcomes from IE, oral antibiotic prophylaxis is recommended for invasive dental procedures, see infective endocarditis.

• Patients with any prosthetic heart valve, including a transcatheter valve, or those in whom any prosthetic material was used for heart valve repair
• patients with a previous episode of infective endocarditis
• patients with some forms of congenital heart disease (CHD):
  1. any type of cyanotic CHD
  2. any type of CHD repaired with prosthetic material, whether placed surgically or by percutaneous techniques, up to 6 months after the procedure, or lifelong if a residual shunt or valvular regurgitation remains.

If the general dental practitioner (GDP) is satisfied/confirms that the patient falls into one of the categories listed above, the NHS Highland Cardiology Service recommends that the GDP initiates the discussion around the risks and benefits of antibiotic prophylaxis without further reference to the cardiology consultant for that patient.  

The definition of invasive dental procedures is provided in the SDCEP Antibiotic Prophylaxis Against Infective Endocarditis Implementation Advice document, Section 4.5.  This NHS Highland guideline is consistent with the most recent 2023 European Society of Cardiology Guidelines for the management of infective endocarditis.

For glossary of terms see Glossary.