How can bacterial endocarditis be prevented?

Traditionally, patients who were considered at risk of developing endocarditis (such as those listed above in the section, “Who is at risk of developing bacterial endocarditis?”) were advised to take antibiotics as a preventive measure before any dental, gastrointestinal or urinary tract procedure. The American Heart Association conducted a review of the scientific literature to determine the value and effectiveness of antibiotic prophylaxis (preventive antibiotics) before such procedures in reducing the risk of bacterial endocarditis.

They found the following information to be proven true, and therefore revised the guidelines for bacterial endocarditis prevention.

Summary of Infective Endocarditis (IE) Prevention Guidelines from the American Heart Association*

Endocarditis is more likely a result of daily exposure to bacteria, rather than exposure during a dental, gastrointestinal tract or genitourinary tract procedure. There may be greater risks from preventive antibiotic therapy than potential benefits if any.

  • You can reduce the risk of bacterial endocarditis by practicing good oral hygiene habits every day. Good oral health is generally more effective in reducing your risk of bacterial endocarditis than is taking preventive antibiotics before certain procedures. Take good care of your teeth and gums by:
    • Seeking professional dental care every six months
    • Regularly brushing and flossing your teeth
    • Making sure dentures fit properly
  • Learn more about good oral hygiene and heart disease
  • Not all endocarditis can be prevented. Call your doctor if you have symptoms of an infection (See signs of infection listed above). Do not wait a few days until you have a major infection to seek treatment. Colds and the flu do not cause endocarditis. But infections that may have the same symptoms (sore throat, general body aches, and fever) do. To be safe, call your doctor.
  • Only the people who have the highest risk for bacterial endocarditis will reasonably benefit from taking preventive antibiotics before certain procedures. The highest risk group for bacterial endocarditis includes those with:
    • An artificial (prosthetic) heart valve, including bioprosthetic and homograft valves
    • Previous bacterial endocarditis
    • Certain congenital heart disease including:
    • Complex cyanotic congenital heart disease such as single ventricle states, transposition of the great arteries, Tetralogy of Fallot
    • Unrepaired cyanotic congenital heart disease, including patients with palliative shunts and conduits
    • Congenital heart disease that is completely repaired by surgery or with a transcatheter device. Endocarditis prevention is reasonable for at least 6 months following the device implant. According to the American Heart Association, after 6 months, there is insufficient data to make recommendations for preventive antibiotic therapy.
    • Repaired congenital heart disease with defects still remaining at the site or next to the site of a prosthetic patch or prosthetic device
    • Heart valve disease that develops after heart transplantation
  • Importantly, the AHA no longer recommends antibiotic prophylaxis for gastrointestinal and genitourinary procedures, such as gastroscopy, colonoscopy, and cystoscopy.

If you are in the high risk group above, please follow these additional guidelines:

  • Tell your doctors and dentists you have heart disease that places you at greater risk of developing endocarditis.
  • Take antibiotics before the following procedures (as recommended by the American Heart Association):
    • All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth, or perforation of the oral mucosa.
    • Procedures of the respiratory tract or infected skin, tissues just under the skin, or musculoskeletal tissue
  • Link to Prevention of Bacterial Endocarditis Wallet Card
  • Check with your doctor about the type and amount of antibiotics you should take. Plan ahead to find out what steps you must take before the day of your procedure.
  • Carry a wallet identification card. A wallet card may be obtained from the American Heart Association with specific antibiotic guidelines. Visit their website or call your local American Heart Association office or nationally, 1.800.AHA.USA1.*

* A new browser window will open with this link. The inclusion of links to other websites does not imply any endorsement of the material on those websites nor any association with their operators.*

Last reviewed by a Cleveland Clinic medical professional on 04/29/2019.


  • Nishimura, RA, et. al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart DiseaseA Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129 (23) e521-e643. Accessed 12/2018
  • Nishimura, RA, et. al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017; 135 (25) e1159-e1195. Accessed 12/2018
  • Habib G, et. al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009) The Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). European Heart Journal (2009) 30, 2369–2413 doi:10.1093/eurheartj/ehp285 Accessed 12/2018
  • Wilson W, et. al. Prevention of Infective Endocarditis Guidelines From the American Heart Association A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007;116:1736-1754 Accessed 12/2018

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