Infective endocarditis, which is more well known as bacterial endocarditis, is an infection of the valves of the heart or of the lining of the heart.
It most commonly occurs when bacteria gets in the blood and then attaches to damaged areas of the heart, and so it is uncommon in children who don't have an underlying heart problem.
Preventing Bacterial Endocarditis
Since many dental and surgical procedures can allow bacteria to get into a child's bloodstream, it was once recommended that kids with any kind of heart condition -- including murmurs -- get preventative antibiotics if undergoing such procedures. This is known as bacterial endocarditis prophylaxis.
New rules for who needs antibiotics before a dental and surgical procedure are much narrower though, and only high-risk children with heart conditions now need antibiotics. According to the American Heart Association, those kids needing antibiotics for endocarditis prophylaxis now only includes those with:
- prosthetic heart valves
- a history of endocarditis
- unrepaired cyanotic congenital heart disease, including those with palliative shunts and conduits
- completely repaired congenital heart disease with prosthetic material or device, whether placed by surgery or catheter intervention, during the first six months after the procedure
- repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device
- cardiac transplantation recipients with cardiac valvular disease
If your child was previously prescribed antibiotics before dental procedures because of a heart condition that isn't on the above list, you should likely talk to your pediatrician, pediatric cardiologist, and/or pediatric dentist to see if they are still required. Common conditions for which preventative antibiotics for endocarditis used to be prescribed, but are no longer needed include:
- mitral valve prolapse
- rheumatic heart disease
- ventricular septal defect
- atrial septal defect
- hypertrophic cardiomyopathy
What You Need To Know
- Endocarditis prophylaxis is required for 'all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa.' This includes extractions, fillings, cleanings, and root canals, for example.
- Antibiotics that are commonly used for endocarditis prophylaxis include amoxicillin, cephalexin, clindamycin, or azithromycin, depending on whether the child has any allergies to antibiotics.
- Antibiotics for endocarditis prophylaxis are usually given as a single dose 30 to 60 minutes before the procedure.
- In addition to dental procedures, endocarditis prophylaxis is also recommended for certain invasive respiratory tract procedures (tonsillectomy and adenoidectomy, bronchoscopy with incision of the respiratory tract mucosa, drainage of an abscess or empyema), and surgical procedures that involve infected skin, skin structures, or musculoskeletal tissues.
- Endocarditis prophylaxis is no longer recommended for most gastrointestinal procedures, such as a colonoscopy, or genitourinary procedures (cystoscopy, VCUG).
Sources:
Wilson et al. American Heart Association Guideline. Prevention of Infective Endocarditis. Circulation. 2007;116:1736-1754.
