VOLUME 31 : NUMBER 6 : December 2008
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Aust Prescr 2008;31:153
Therapeutic Guidelines has revised the guidelines for the use of antibiotics for prophylaxis against infective endocarditis (see www.tg.org.au/Prevention_of_endocarditis_update). The major change is that antibiotic prophylaxis is no longer indicated in patients with aortic stenosis, mitral stenosis, or symptomatic or asymptomatic mitral valve prolapse.
The justifications and reasoning behind these changes have been reviewed in the Australian Dental Journal.1 These new guidelines take into consideration the guidelines of the American College of Cardiology/American Heart Association, as well as the British Society for Antimicrobial Chemotherapy and the UK National Institute for Health and Clinical Excellence. The most recent UK guidelines do not recommend antibiotic prophylaxis for any cardiac risk group. Prophylaxis is also not indicated in adolescents and young adults with heart valve disease, apart from indigenous Australians.
The Australian infective endocarditis prophylaxis guidelines differ from the American and UK guidelines in two specific ways:
Doctors and dentists need to be prepared to discuss the updated guidelines as these changes are bound to concern patients who previously received prophylaxis. The changes may be more of a slow evolution as both patients and clinicians come to appreciate the lack of evidence for a benefit of antibiotic prophylaxis.
See also National Prescribing Service (NPS) patient information leaflet 'Preventing infections of the heart' at www.nps.org.au/health_professionals/patient_resources/patient_leaflets