Secondary prevention
Patients with a history of prosthetic valve replacement, a previous history of infective endocarditis, select patients with congenital heart disease, and cardiac transplant recipients are at high risk of developing infective endocarditis. Therefore, the American College of Cardiology/American Heart Association guidelines recommend that these patients receive antibiotic prophylaxis for dental procedures that involve:[10]
Manipulation of gingival tissue
Manipulation of the periapical region of teeth
Perforation of the oral mucosa.
The guidelines further suggest that there is no evidence for infective endocarditis prophylaxis in gastrointestinal procedures or genitourinary procedures where there is no known infection. However, European guidelines recommend routine antibiotic prophylaxis for infective endocarditis prior to at-risk dental procedures, or invasive gastrointestinal, respiratory, skin, musculoskeletal, or genitourinary procedures may be offered, depending on the patient's risk profile.[33] See Infective endocarditis.
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