The Medical Letter on Drugs and Therapeutics
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1275
Major Changes in Endocarditis Prophylaxis for Dental, GI and GU Procedures
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Revised 12/13/07: Highest-Risk Procedures paragraph: 6th line, the word "rubber" has been omitted since it does not justify prophylaxis; placement of orthodontic metal bands does.

The American Heart Association has issued its revised guidelines for prevention of infective endocarditis.1 Antimicrobial prophylaxis for dental procedures is now recommended only for patients at the highest risk of severe consequences from endocarditis who are undergoing the highest-risk procedures. Endocarditis prophylaxis is no longer recommended for gastrointestinal (GI) and genitourinary (GU) procedures. When these changes are implemented, the number of patients receiving antimicrobial prophylaxis to prevent endocarditis should decline sharply.

HIGHEST-RISK PATIENTS — The risk of severe consequences from endocarditis after dental procedures is highest in patients with previous bacterial endocarditis, prosthetic heart valves, or unrepaired cyanotic congenital heart disease such as tetralogy of Fallot, including those with surgically constructed palliative shunts or conduits. Patients are also ... more      

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Title: Major Changes in Endocarditis Prophylaxis for Dental, GI and GU Procedures
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