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Antibiotic prophylaxis against infective endocarditis: time to rethink

Robert F W Moulds and Melanie S Jeyasingham
Med J Aust 2008; 189 (6): . || doi: 10.5694/j.1326-5377.2008.tb02044.x
Published online: 15 September 2008

A decade of research has led to more precise guidelines for a complex health problem

It has long been considered that all patients with heart conditions that predispose to infective endocarditis should receive antibiotic prophylaxis when undergoing procedures that can lead to bacteraemia with organisms known to cause endocarditis. However, the evidence for such action is surprisingly poor.1 It is based on isolated case reports of endocarditis following dental or other procedures, and on theoretical considerations, rather than the results of randomised controlled trials.


  • 1 Fiji School of Medicine, Suva, Fiji.
  • 2 Therapeutic Guidelines Limited, Melbourne, VIC.


Correspondence: r.moulds@fsm.ac.fj

  • 1. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 116: 1736-1754.
  • 2. Antibiotic Expert Group. Therapeutic guidelines: antibiotic. Version 13. Melbourne: Therapeutic Guidelines Limited, 2006.
  • 3. Roberts GJ. Dentists are innocent! “Everyday” bacteremia is the real culprit: a review and assessment of the evidence that dental surgical procedures are a principal cause of bacterial endocarditis in children. Pediatr Cardiol 1999; 20: 317-325.
  • 4. Bhanji S, Williams B, Sheller B, et al. Transient bacteremia induced by toothbrushing a comparison of the Sonicare toothbrush with a conventional toothbrush. Pediatr Dent 2002; 24: 295-299.
  • 5. Forner L, Larsen T, Kilian M, Holmstrup P. Incidence of bacteremia after chewing, tooth brushing and scaling in individuals with periodontal inflammation. J Clin Periodontol 2006; 33: 401-407.
  • 6. Kinane DF, Riggio MP, Walker KF, et al. Bacteraemia following periodontal procedures. J Clin Periodontol 2005; 32: 708-713.
  • 7. Gould FK, Elliott TS, Foweraker J, et al. Guidelines for the prevention of endocarditis: report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2006; 57: 1035-1042.
  • 8. National Institute for Health and Clinical Excellence. Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditits in adults and children undergoing interventional procedures. London: NICE, 2008. http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11938 (accessed Aug 2008).

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