Editing Infective endocarditis (section)

==Prevention==
Not all people with heart disease require antibiotics to prevent infective endocarditis. Heart diseases have been classified into high, medium and low risk of developing IE. Those falling into high risk category require IE prophylaxis before endoscopies and urinary tract procedures.
Diseases listed under high risk include:<ref name="auto"/>
* Prior endocarditis
* Unrepaired cyanotic congenital heart diseases
* Completely repaired congenital heart disease in their first 6 months
* Prosthetic heart valves or valves repaired with any prosthetic material
* Incompletely repaired congenital heart diseases
* Cardiac transplant valvulopathy

Following are the antibiotic regimens recommended by the American Heart Association for antibiotic prophylaxis:<ref name="AHA_2007"/>
: Oral amoxicillin one hour before the procedure
: Intravenous or intramuscular ampicillin one hour before the procedure
:In patients allergic to penicillins
:: Azithromycin or clarithromycin orally one hour before the procedure
:: Cephalexin orally one hour before the procedure
:: Clindamycin orally one hour before the procedure

In the UK, NICE clinical guidelines no longer advise prophylaxis because there is no clinical evidence that it reduces the incidence of IE and there are negative effects (e.g. allergy and increased bacterial resistance) of taking antibiotics that may outweigh the benefits.<ref name="NICE_CG64">{{cite web | url=http://publications.nice.org.uk/prophylaxis-against-infective-endocarditis-cg64 | title=Prophylaxis against infective endocarditis: Antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures | publisher=National Institute for Health Care and Excellence (UK) | work=NICE Clinical Guidelines | date=March 2008 | access-date=2013-04-30 | url-status=dead | archive-url=https://web.archive.org/web/20130126164822/http://publications.nice.org.uk/prophylaxis-against-infective-endocarditis-cg64 | archive-date=2013-01-26 }}</ref>

Antibiotics were historically commonly recommended to prevent IE in those with heart problems undergoing dental procedures (known as [[dental antibiotic prophylaxis]]). There is, however, insufficient evidence to support whether antibiotics are effective or ineffective at preventing IE when given prior to a dental procedures in people at high risk.<ref>{{cite journal | vauthors = Rutherford SJ, Glenny AM, Roberts G, Hooper L, Worthington HV | title = Antibiotic prophylaxis for preventing bacterial endocarditis following dental procedures | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 5 | pages = CD003813 | date = May 2022 | pmid = 35536541 | pmc = 9088886 | doi = 10.1002/14651858.CD003813.pub5 }}</ref> They are less commonly recommended for this procedure.<ref>{{Cite journal|date=2008|title=Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures.|journal=National Institute for Health and Care Excellence}}</ref>

In some countries e.g. the US, high risk patients may be given prophylactic antibiotics such as [[penicillin]] or [[clindamycin]] for penicillin-allergic people prior to dental procedures.<ref name="Bagg_2006" /> Prophylactics should be [[bactericidal]] rather than [[bacteriostatic]].<ref name="Bagg_2006" /> Such measures are not taken in certain countries e.g. Scotland due to the fear of [[antibiotic resistance]].<ref>{{Cite news|url=http://www.sdcep.org.uk/published-guidance/drug-prescribing/|title=Drug Prescribing |work=SDCEP|access-date=2018-01-25|language=en-US}}</ref> Because bacteria are the most common cause of infective endocarditis, antibiotics such as [[penicillin]]<ref name="Bagg_2006" /> and [[amoxicillin]] (for [[beta lactamase]]-producing bacteria) are used in prophylaxis.{{citation needed|date=November 2021}}