Antibiotic prophylaxis for bacterial endocarditis unnecessary for most deliveries . . .

. . . not to mention for most dental procedures, according to the newest guidelines from the American Heart Association.

The authors of the guidelines conclude that infective endocarditis (IE) is much more likely to result from exposure to random bacteremia in daily life than from bacteremia caused by dental, gastrointestinal, or genitourinary procedures, and that it is no longer even certain that prophylaxis will successfully prevent IE in people who undergo these procedures. If it does, the number of cases it prevents is exceedingly small.

The report says that because AHA now believes that the risk of antibiotic-related adverse events exceeds the benefit of prophylaxis, administering antibiotics solely to prevent IE is no longer recommended for people undergoing these procedures. Prophylaxis is recommended prior to dental procedures, procedures on the respiratory tract or infected skin, skin structure, or musculoskeletal tissue for people with "underlying cardiac conditions associated with the highest risk of adverse outcome from IE," which includes those with a prosthetic cardiac valve, previous IE, congenital heart disease, and cardiac transplantation recipients who develop cardiac valvulopathy.

Commentary by Paula J. Adams Hillard, MD, Acting Professor, Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, Calif:

The latest iteration of the American Heart Association's guidelines for prevention of infective endocarditis concludes that: "Antibiotic prophylaxis solely to prevent IE is not recommended for GU or GI tract procedures." The previous guidelines from 1997 provided a list of GU/gynecologic procedures for which prophylaxis was and was not recom-mended. These new guidelines result in many fewer patients for whom IE prophylaxis is recommended. The report concludes that no published data demonstrate a conclusive link between procedures of the GU tract and the development of IE, and that no studies exist to demonstrate that the administration of prophylaxis prevents IE in association with these procedures.