Endocarditis: Prevention Menu

Prevention of Endocarditis

Infectious endocarditis occurs from a sequence of events:

  • An abnormal or damaged endothelial surface, such as on heart valves, cause the formation of a thrombus
  • Transient circulation of bacteria in the bloodstream exposes this damaged area to the bacteria
  • Seeding and proliferation of the bacteria which also causes the accrual of platelets and other inflammatory substances

The concept of preventing endocarditis with prophylactic antibiotics during times of theoretical introduction of bacteria into the bloodstream (during procedures) is not a fact; studies have ranged from helpful to inconclusive. But the rationale based on the sequence of events (above) makes prevention center on those who have the highest risks for it:

  • Heart disease (excluding hypertrophic cardiomyopathy)
  • Valvular disease (excluding bicuspid aortic valve and mitral valve prolapse)
  • Prosthetic valves
  • Previous endocarditis
  • Repaired congenital cardiac anomalies
  • IV drug abusers
  • Extensive dental disease
  • Renal and dialysis patients

As the theoretical cause of bacterial “seeding” of the heart valves is from introduction of bacteria into the blood stream, those at increased risk should have prophylactic antibiotic coverage for any “instrumentation” that could result in this introduction into the blood stream. The protocol for antibiotic prophylaxis includes beginning the antibiotics before a procedure, so that antibiotic blood levels are sufficient at the time of bacterial seeding to prevent valvular involvement.

Examples Include:

  • Dental procedures
  • Respiratory tract surgical procedures (tonsillectomy, adenoidectomy, or bronchoscopy that includes biopsy)
  • Gynecological procedures (dilation and curettage, terminations, endometrial biopsies)
  • Obstetrical procedures (amniocentesis, chorionic villous sampling, and artificial rupture of membranes before vaginal delivery)
  • Incision and drainage of abscesses
  • Dialysis via an arteriovenous graft or shunt
  • Arterial stenting procedures
  • Other surgery

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This information is provided by Vascular Health Clinics and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.

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