Perioperative antibiotic prophylaxis in adults - Sistema Nazionale ...

diagnostic or surgical procedures and on the efficacy of prophylaxis were stilllacking. The 1997 update, while not substantially altering prophylactic strategy,acknowledged for the first time that most cases of endocarditis are the result ofrandomly occurring bacteraemias rather than of particular diagnostic procedures.This and a series of other considerations listed below were formulated over the yearsand led to a radically new approach in the update published by the AHA in August2007 212 :• the occurrence of bacterial endocarditis is much more likely to result fromexposure to episodes of bacteraemia associated with daily activities than frombacteraemia caused by diagnostic or surgical procedures in the mouth, GI tractor GU tract,• antibiotic prophylaxis can prevent an exceedingly small number of cases ofbacterial endocarditis in patients undergoing dental, GI tract or GU tractdiagnostic or surgical procedures;• the risk of adverse events associated with antibiotic prophylaxis is greater thanthe benefits;• maintenance of optimal oral health and hygiene and periodic odontoiatriccheck-ups may reduce the incidence of bacteraemia associated with dailyactivities and are more important and effective than antibiotic prophylaxisadministered in association with odontoiatric procedures.The following are the latest recommendations for antibiotic prophylaxis to preventbacterial endocarditis published by the AHA in August 2007 212 .Patients at high risk of developing endocarditis: antibiotic prophylaxisis recommended only for patients with these cardiac conditions• prosthetic cardiac valve• previous history of endocarditis (including without valve lesion)• congenital heart disease, in particular: