American Heart Association (AHA) 2007 guidelines on the prevention of Infective endocarditis

A 37-year-old woman with a history of mitral valve prolapse and mitral regurgitation presents for evaluation. She reports no symptoms of shortness of breath or exercise intolerance. She plans to undergo health screening procedures, including dental exams for routine cleaning and filling of several caries, pelvic exam colonoscopy in the next year.
According to the American Heart Association (AHA) 2007 guidelines on the prevention of infective endocarditis, what should she receive prior to these procedures?

A) Amoxicillin 2 g PO.
B) Azithromycin 500 mg PO.
C) Clindamycin 600 mg PO.
D) Nothing.


Answer And Discussion

The correct answer is “D.” Nothing.

In 2007, there were major changes to the AHA guidelines on infective endocarditis prevention. The one change that would seem to affect the greatest number of patients in primary care practices is the “downgrading” of mitral valve prolapse with regurgitation, which is no longer considered a high-risk condition. If the patient had a condition for which prophylaxis was warranted, all of the
other regimens (A, B, C) are options depending on the patient’s allergies, etc.

The guidelines recommend antibiotic prophylaxis for conditions considered to be high risk for adverse outcomes of infective endocarditis.
High-risk conditions include:

• prosthetic valves (bioprosthetic homograft and allograft valves and mechanical valves),
• previous infective endocarditis, 
• complex cyanotic congenital heart disease

Moderate-risk conditions, for which prophylaxis is not indicated, include:

• acquired valvular dysfunction, such as rheumatic heart disease, hypertrophic cardiomyopathy, bicuspid aortic valve, and mitral valve prolapse with auscultatory evidence of valvular regurgitation and/or thickened leaflets.