NICE states that the following cardiac conditions put patients at higher risk of IE:

• Previous IE
• Valve replacement 
• Acquired valvular stenosis / regurgitation 
• Hypertrophic cardiomyopathy
• Congenital structural heart diseaseESC defines structural heart disease as an abnormality in the heart structure - valve / wall / chamber / great vessel. Note that coronary artery disease itself does not fall under the category of structural heart disease. Common congenital structural heart diseases: ⦁ ASD ⦁ VSD ⦁ Tetralogy of Fallot ⦁ Bicuspid aortic valve

Selected points from NICE, ESC, AHA guidelines to prevent IE:

• Maintain good oral hygiene
• Avoid non-essential invasive procedures (e.g. skin piercing, tattooing)
• Avoid IVDUIntravenous drug use
• Patient education

Antibiotic prophylaxis is NOT recommended routinely.

NICE specifically states that in the following scenarios, routine antibiotic prophylaxis against IE is not recommended:

• Dental procedures
  • Chlorhexidine mouthwash shouldn’t be offered as prophylaxis for dental procedures

 

• Non-dental procedures at the following sites:
  • Upper and lower GI tract
  • Upper and lower respiratory tract (including ENT procedures and bronchoscopy)
  • Genitourinary tract (including urological, O&G procedures, childbirth)

NICE recommends that if a person is at risk of IE and is receiving antimicrobial therapy due to a GIGastrointestinal / GUGenito-urinary procedure for suspected infection → give antibiotics that cover IE organisms. 

BNF recommends antibiotic therapy depending on native or prosthetic valve IE:

• Native valve
  • 1^st line: amoxicillin / ampicillin +/- gentamicin
  • Penicillin allergic / MRSA suspected / severe sepsis: vancomycin + gentamicin
  •  Severe sepsis with RF for gram -ve infection: vancomycin + meropenem

 

• Prosthetic valve
  • 1^st line: vancomycin + rifampicin + gentamicin (low-dose)

Duration of antibiotic therapy: generally 4-6 weeks

Recommended antibiotics by BNF:
 

Organism	1st line antibiotic	2nd line (MRSA / penicillin allergic)
Staphylococci	Native valve → flucloxacillin	Native valve → vancomycin + rifampicin
	Prosthetic valve → flucloxacillin + rifampicin + gentamicin	Prosthetic valve → vancomycin + rifampicin + gentamicin
Streptococci	Benzypenicillin	Vancomycin / teicoplanin + gentamicin
Enterococci	Amoxicillin / ampicillin + gentamicin / benzylpenicillin	Vancomycin / teicoplanin + gentamicin
HACEK microorganisms Gram -ve organisms that are typically oropharyngeal commensals ⦁ Haemophilus species ⦁ Aggregatibacter actinomycetemcomitans ⦁ Cardiobacterium hominis ⦁ Eikenella corrodens ⦁ Kingella kingae	Amoxicillin / ampicillin + gentamicin	Ceftriaxone / cefotaxime + gentamicin

NICE guideline Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures
BNF treatment summary: cardiovascular system infections, antibacterial therapy

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