Which patients should receive endocarditis prophylaxis?
Prophylaxis against endocarditis is recommended for patients with abnormal or prosthetic heart valves, patients with a history of endocarditis, even in the absence of heart disease, surgically constructed systemic-pulmonary shunts, most congenital cardiac malformations, hypertrophic cardiomyopathy, and mitral valve prolapse (MVP) with valvular regurgitation (Tables 7.1, 7.2). Prophylaxis in certain classes of patients is controversial. Some patients with MVP have dynamic regurgitation that disappears with certain maneuvers. Also, echocardiography occasionally detects regurgitation when auscultation does not. Some have recommended that such patients do not require prophylaxis unless they are found to have thickening of mitral valve leaflets and redundancy on echocardiography.
Patients with prosthetic heart valves, a previous history of endocarditis, or surgically constructed shunts are considered to be at high risk for developing endocarditis. Infection in these patients is associated with significant morbidity and mortality. In the past, only parenteral prophylaxis was recommended. Currently, oral prophylaxis regimens are acceptable.
Prophylaxis is not recommended for patients who have had coronary artery bypass surgery, innocent murmurs, previous rheumatic heart disease without valvular disease, cardiac pacemakers, implantable defibrillators, and surgical repair of secundum atrial septal defects, or patent ductus arteriosus ligation.