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Infective endocarditis prophylaxis: current practice trend among paediatric cardiologists: are we following the 2007 guidelines?

Published online by Cambridge University Press:  30 December 2015

Ronak J. Naik ,
Neil R. Patel ,
Ming Wang  and
Nishant C. Shah Open the ORCID record for Nishant C. Shah [Opens in a new window]
Ronak J. Naik
Affiliation:
Department of Pediatrics, The University of Tennessee Health Science Center and Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
Neil R. Patel
Affiliation:
Icahn School of Medicine at Mount Sinai, Center for Advanced Medicine, New York, New York, United States of America
Ming Wang
Affiliation:
Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
Nishant C. Shah*
Affiliation:
Department of Pediatrics, Penn State Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
*
Correspondence to: N. C. Shah, Department of Pediatrics, Penn State Hershey Medical Center, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, United States of America. Tel: 001-717-531-2050; Fax: 001-717-531-2052; E-mail: [email protected]
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Abstract

Background

In 2007, the American Heart Association modified the infective endocarditis prophylaxis guidelines by limiting the use of antibiotics in patients with cardiac conditions associated with the highest risk of adverse outcomes after infective endocarditis. Our objective was to evaluate current practice for infective endocarditis prophylaxis among paediatric cardiologists.

Methods

A web-based survey focussing on current practice, describing the use of antibiotics for infective endocarditis prophylaxis in various congenital and acquired heart diseases, was distributed via e-mail to paediatric cardiologists. The survey was kept anonymous and was distributed twice.

Results

Data from 253 participants were analysed. Most paediatric cardiologists discontinued infective endocarditis prophylaxis in patients with simple lesions such as small ventricular septal defect, patent ductus arteriosus, and bicuspid aortic valve without stenosis or regurgitation; however, significant disagreement persists in prescribing infective endocarditis prophylaxis in certain conditions such as rheumatic heart disease, Fontan palliation without fenestration, and the Ross procedure. Use of antibiotic prophylaxis in certain selected conditions for which infective endocarditis prophylaxis has been indicated as per the current guidelines varies from 44 to 83%. Only 44% follow the current guidelines exclusively, and 34% regularly discuss the importance of oral hygiene with their patients at risk for infective endocarditis.

Conclusion

Significant heterogeneity still persists in recommending infective endocarditis prophylaxis for several cardiac lesions among paediatric cardiologists. More than half of the participants (56%) do not follow the current guidelines exclusively in their practice. Counselling for optimal oral health in patients at risk for infective endocarditis needs to be optimised in the current practice.

Keywords

Infective endocarditiscongenital heart diseasepaediatric cardiology
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 6 , August 2016 , pp. 1176 - 1182
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Copyright
© Cambridge University Press 2015 

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