What is an Endocarditis Prophylaxis?

Endocarditis prophylaxis is the prevention of bacterial infection of the heart prior to certain types of exposure that may elevate this risk. It is more commonly termed bacterial endocarditis or BE prophylaxis and it is a very important part of treatment under some circumstances for certain members of the population. What is meant by prophylaxis is that a medical step is taken that is preventative rather than curative. In the case of endocarditis prophylaxis, this typically means administering antibiotics prior to any treatment that poses a risk for bacteria entering the bloodstream and making its way to the heart where it begins to grow and obstruct heart function (endocarditis).

There are a number of people identified as needing infectious or bacterial endocarditis prophylaxis. These groups mostly include those who have some form of heart disease or who have undergone certain types of heart repair. Included in these groups are most people with congenital heart defects, those who have had surgery on or replacement of heart valves, people who’ve received heart transplants, and those who in the past have had cases of bacterial endocarditis. For the average person with a healthy heart, BE prophylaxis is usually not recommended.

The circumstances under which a person receives endocarditis prophylaxis usually have to do with receiving dental care. Since the mouth can naturally contain lots of bacteria, any cuts to the gums can make it easy for bacteria to enter the bloodstream quickly. There are other times when endocarditis prophylaxis is also recommended, and these can include people who have had medical procedures on the genitals or urinary (genitourinary) tract or on the gastrointestinal tract. These also run greater risk of introducing bacteria into the bloodstream.

To avoid this risk, the present endocarditis prophylaxis guidelines are to give antibiotics in a single large dose prior to any procedure deemed of risk, about an hour before the procedure takes place. Specific dosage and type of antibiotic used depends on the individual, age, and size. Until recently, people would take antibiotics both before and after any procedure, such as when they received a dental cleaning. In recent years organizations like the American Heart Association (AHA) have changed these guidelines and now suggest that the dose before is really sufficient. Given concern about overuse of antibiotics, the AHA also has much stricter language when it comes to its recommendations for prophylaxis, and suggests only the above groups mentioned receive it.

For those who are at greater risk for bacterial endocarditis, it can be concerning that BE prophylaxis doesn’t fully cover all incidences when infection could occur. It may be too late to treat for endocarditis after receiving an injury to the mouth that breaks the skin. Nevertheless, endocarditis prophylaxis can at least decrease risk of infection when known exposure occurs. Observing good dental health is another prophylactic measure, which can lower risk of infection.