Infective Endocarditis

What is Infective Endocarditis?


Infective Endocarditis (IE) is an infection of the inner lining of the heart. While this condition is relatively rare, it is a very serious condition which can lead to severe complications and in some instances can be potentially fatal.

It is usually caused by bacteria entering into the blood and travelling to the heart. Treatment for IE is not straightforward as many patients require a long period of intravenous antibiotics (six weeks minimum)and in many cases, surgery will be required to repair or replace any damaged structures of your heart.

 

Who is at risk of Infective Endocarditis?


The heart is usually well protected from infection, although there are certain conditions that can make it easier for bacteria to evade the immune system. This means that while everyone may be at risk of developing IE, there are some people who are at a higher risk. These include:


• Patients with prosthetic (artificial) heart valves: either by open heart surgery or from a catheter procedure (from top of the leg);
• People whom have had a previous episode of IE: these individuals also have a higher risk of complications;
• Patients with some forms of congenital heart disease (CHD), including;

  • Any type of cyanotic CHD, patients that have low oxygen saturations.
  • Any type of CHD that has been repaired with prosthetic material up to six months after the procedure or lifelong if there is a residual shunt (oxygen rich blood mixing with oxygen deplete blood) or valvular regurgitation (leaky valves).

Should I have antibiotics if I am going to the dentist?


There has been a change in the guidelines recently to suggest what we should do to try and reduce the risk of Infective Endocarditis. The new recommendations suggest that if you are at higher risk then you should receive antibiotic cover for specific dental treatments, such as:


• Root canal;
• Scaling; and
• Any treatments which involve manipulation of gingival (gum) or periapical (root) region of the teeth or perforation of the oral mucosa.

 

The antibiotics that are recommended for these procedures are displayed in the table below:

 

Single dose 30-60 minutes before the procedure

Situation

Antibiotic

Adults

Children

No allergy to penicillin or ampicillin

Amoxicillin

2g orally or intravenous

50 mg/kg orally or intravenous

Allergy to penicillin or ampicllin

Clindamycin

600mg orally or intravenous

20mg/kg orally or intravenously

We would advise that antibiotics should not be taken for:

  • Local anaesthetic injections into non-infected areas;
  • Treatment of superficial caries;
  • Removal of sutures;
  • Placement or adjustment of removable prosthodontic or orthodontic appliances or braces following the removal of milk (deciduous) teeth; or
  • Trauma to the lips or oral area.

Should I have antibiotics for non-dental procedures?

 

Antibiotics prophylaxis is not recommended for non-dental procedures.  Antibiotic therapy is only needed when invasive procedures are performed to treat an infection.

 

What Else Can I Do to Reduce the Risk of Infective Endocarditis?

 

To try and reduce the risk of developing endocarditis there are several things that we recommend to all patients:

  • Regular dental checkups: ideally every six months.  Do not let gum disease or dental abscesses go untreated.
  • Disinfection of cuts or grazes to prevent them becoming infected.
  • Curative antibiotics for any bacterial infection.
  • Avoid self medication of antibiotics.
  • Avoid piercings and tattoos.

 

This advice regarding IE prophylaxis is taken from the ESC Guidelines published in 2015.  They can be accessed directly at: http://eurheartj.oxfordjournals.org/content/ehj/early/2015/08/28/eurheartj.ehv319.full.pdf

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