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AHA 2021 Statement on Prevention of Infective Endocarditis


The American Heart Association (AHA) has issued an update to its 2007 guideline entitled Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement from the American Heart Association. The statement concludes there are no recommended changes to the 2007 guidelines for the prevention of viridans group streptococcal infective endocarditis (VGS IE).

The College is updating members on the background and current status of VGS IE, and how information from the 2021 statement may affect everyday clinical practice. Here are the key points from the AHA statement:

  • VGS IE is more likely to develop from routine activities such as chewing food, toothbrushing and oral hygiene procedures.
  • Antibiotic prophylaxis (AP) before dental procedures may prevent an extremely small number of VGS IE cases. Accordingly, AP is suggested only for patients with the highest risk of an adverse outcome from VGS IE.
  • Since publication of the 2007 guidelines there is no evidence of an increased frequency of or mortality from VGS IE in patients at all risk levels.
  • Except for two changes, the AP regimen for single dose prevention of VGS IE remains similar to the 2007 guidelines:
  • Because it may cause more frequent and severe reactions than other antibiotics, clindamycin is no longer recommended as a pre-operative antibiotic for VGS IE prophylaxis.
  • Doxycycline for AP is now an option for patients allergic to penicillin.
  • The 2021 list of cardiac conditions for which AP is suggested is substantially similar, with some minor additions.
  • Maintaining good oral health and accessing regular dental care is considered more important than antibiotic prophylaxis before a dental procedure to prevent VSG IE.
  • It is important that dentists become familiar with the 2021 AHA suggestions so that patients can make an informed decision about the risks and benefits of AP before dental procedures.

The complete article is available in Circulation. 2021;143:00–00, and by clicking this link: https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000969

The 2007 article from Circulation is available here: Prevention of Infective Endocarditis (ahajournals.org)