Bacterial Endocarditis and Prophylaxis in Dentistry

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Antibiotic prophylaxis is an established requirement in the management of patients with cardiac related diseases at risk of bacterial endocarditis in the course of dental manipulation.

Predisposing risk factors include previous history of bacterial endocarditis, history of heart valve disease and a history of heart valve replacement.

Cause

  • Streptococcus sanguis 
  • Streptococcus mitis 
  • Streptococcus mutans
  • Streptococcus salivarius 
  • Other oral bacterial flora

TreatmentTreatment Objectives

To prevent seeding of oral bacteria during the transient bacteraemic phase during dental manipulation into intra-cardiac defects and valvular lesions 

Pharmacological treatment  1st Line Treatment

Evidence Rating: [B]

  • Amoxicillin (Amoxycillin), oral,

Adults

2 g stat. (2 hours before procedure)

Children

50 mg/kg stat. (2 hours before procedure) 

Or

  • Clindamycin, oral,

Adults   

600 mg stat. (1 hour before procedure)

Children

20 mg/kg stat. (1 hour before procedure)

Referral Criteria

Refer to a cardiologist if cardiac status cannot be ascertained or history is not clear.