New Guidelines from AHA regarding infective endocarditis Miriam Ika, Jessica Hilton, Emily Lloyd, Michelle Fambrough, Francesca Mustari, Lori Brannin, Chelsa Bringhurst, Kevin Echols

New Findings For decades, the decades American Heart Association recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. Antibiotics were taken with a belief that they would prevent infective endocarditis (IE), previously referred to as bacterial endocarditis. In April 2007, the AHA published new guidelines with good news: the AHA recommends that most of these patients no longer need short-term antibiotics as a preventive measure before their dental treatment.

America’s Associations in Agreement American Dental Association The Infectious Diseases Society of America Pediatric Infectious Diseases Society All groups participated in the development of the new guidelines and it has approved the new standards.

Most Effective Treatment The guidelines are based on a growing body of scientific evidence that shows the risks of taking preventive antibiotics are greater than the benefits for most patients.

Risks Adverse reactions to antibiotics to mild to potentially severe cases. Inappropriate use of antibiotics can also lead to the development of drug-resistant bacteria. Unnecessary use of antibiotics could cause allergic reactions and dangerous antibiotic resistance.

Evidence of Findings Scientists found no compelling evidence that taking antibiotics prior to a dental procedure prevents IE in patients who are at risk of developing a heart infection. Their hearts already are often exposed to bacteria from the mouth, which can enter their bloodstream during basic activities such as brushing of flossing. The new guidelines are based on a comprehensive review of published studies that suggest IE is more likely to occur as a result of everyday activities then from a dental procedure.

Patients include those with: The recommendations for preventative antibiotics are still be recommended for the following groups of at risk people Patients include those with: Artificial heart valves A history of having had IE Certain specific, serious congenital heart conditions including : Unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits.

Continuation… a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter interventions, during the first six months after the procedure. Any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch are prosthetic device. A cardiac transplant which develops a problem in a heart valve. Hypertrophic cardiomyopathy Heart valves damaged by conditions such as rheumatic fever.

Staphylococcus Aureus

Staphylococcus Aureus Gram Positive Most resistant of all non-spore forming bacteria, which also lack flagella Enzymes Coagulase –causes clotting Hyaluronidase-digest hyaluronic (cement between cells) Penicillinase and other enzymes deactivate drugs, by breaking down the bata-lactam ring