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Antibiotic Pre-Medication for Heart Conditions

April 2007

For decades, the American Heart Association (AHA) recommended that patients with certain heart conditions take antibiotics before dental treatments to prevent infective endocarditis (IE). However, new guidelines published in April 2007 in the journal Circulation state that most of these patients no longer need preventive antibiotics.

New Guidelines and Recommendations

The guidelines, developed with input from the American Dental Association, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society, are based on scientific evidence showing that the risks of taking antibiotics outweigh the benefits for most patients. Risks include allergic reactions, the development of drug-resistant bacteria, and potential severe side effects.

Research suggests that everyday activities like brushing and flossing introduce bacteria into the bloodstream more frequently than dental procedures, making preventive antibiotics largely unnecessary for most patients.

Who No Longer Needs Antibiotic Pre-Medication?

Patients who previously took antibiotics but no longer need them include those with:

• Mitral valve prolapse
• Rheumatic heart disease
• Bicuspid valve disease
• Calcified aortic stenosis
• Congenital heart conditions (e.g., ventricular septal defect, atrial septal defect, hypertrophic cardiomyopathy)

Who Still Needs Preventive Antibiotics?

Antibiotics before dental procedures are still recommended for patients with:

• Artificial heart valves
• A history of infective endocarditis
• Serious congenital heart conditions, such as:
  • Unrepaired or incompletely repaired cyanotic congenital heart disease
  • Completely repaired congenital heart defects with prosthetic material (first six months after surgery)
  • Repaired congenital heart defects with residual defects at or near prosthetic patches/devices
• Heart transplant patients with valve issues

Consulting Your Doctor

The updated guidelines apply to dental procedures like cleanings and extractions. Patients with congenital heart disease should consult their cardiologist if they are unsure whether they fall into a high-risk category.