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Up to date causal relationship has been demonstrated between dental manipulations and the onset of infective endocarditis (IE). However, since 1955, numerous expert committees have proposed antibiotic prophylaxis (AP) to prevent bacteraemia of oral origin. Controversy regarding the efficacy of AP prior to the dental procedures has intensified in recent years because of the lack of conclusive evidence on its efficacy for the prevention of IE and on its cost-effectiveness, as well as the possibility of allergic reactions and the emergence of antibiotic resistance. Accordingly, AP is now maintained exclusively for patients at highest risk and who require the manipulation of the gingival or periapical regions of the teeth or perforation of the oral mucosa. In the context of a restrictive policy, the National Institute for Health and Clinical Excellence (NICE) of the United Kingdom published a new guideline in 2008 stating that “AP against IE is not recommended for persons undergoing dental procedures”, regardless of risk status and of the nature of the procedure to be performed. The NICE guideline has generated further controversy, and expert committees in other countries continue to publish prophylactic regimens for the prevention of IE secondary to dental procedures. In this chapter, we discuss the principal guidelines currently applicable in Europe, the USA and Australia, and we draw particular attention to the need for randomised clinical trials.

Antibiotic Prophylactic Regimens for Infective Endocarditis in Patients Undergoing Dental Procedures