Pediatria pre prax 6/2013

Prevention of infective endocarditis in children

Author’s aim was to summarize current state of art on prevention of infective endocarditis (IE) in the light of last guidelines of international professional societies, concentrating more to pediatric aspect of the problem. IE is rare disease with high mortality and morbidity, expensive treatment and risk of unfavorable long term prognosis. For more than 50 years there is ambition to prevent IE by administration of antibiotic prophylaxis before interventions associated with possible bacteraemia which in predisposed patients could end up as IE. Current guidelines drastically reduced spectrum of patients and interventions with recommended IE prevention, in some countries it was even completely withdrawn. Arguments for radical change are as follow: large proportion of IE-causing bacteraemia may rather derive from daily routine activities as tooth brushing than from dental, gastrointestinal a genitourinary intervention. Maintaining good oral hygiene and regular good dental care may decrease incidence of bacteraemia from daily activities and is probably more important than prophylactic antibiotics for dental procedures. European Society of Cardiology considers antibiotic prophylaxis of IE only to patients at highest risk of IE for the highest risk interventions. In children it involves mostly cyanotic congenital heart defects, unoperated or operated with residual defect, palliative shunts or conduits, postoperative defects with the use of prosthetic material without residual defect for six months or residual defects near the prosthetic material. However, guidelines should not be taken as a blind dogma; the ultimate judgment regarding the care of an individual patient must be made by the physician in charge who takes into account all involved factors.

Keywords: infective endocarditis, antibiotic prophylaxis, congenital heart defects.