SBE Prophylaxis - Background
Children with certain forms of congenital heart defects are at higher risk of getting infections in the heart during times when bacteria may enter the bloodstream. Although this is very rare, it does happen on occasion and at times may be very serious. In fact, a bacterial infection in the heart can be life-threatening.
Bacteria living in the mouth and between the teeth and gums may occasionally enter the bloodstream briefly during times of dental work or dental surgery. In a child that has turbulent blood flow in the heart, as is common with many forms of congenital heart defects, bacteria may get caught up in the currents and jets formed by turbulence and find it easier to attach to valves or the heart wall. This can subsequently increase the risk of a heart infection. Therefore, the American Heart Association recommends using antibiotics prophylactically prior to certain medical and surgical procedures to minimize this potential risk of infection.
Current SBE Prophylaxis Recommendations
For many years, the American Heart Association recommended using antibiotics for all forms of congenital heart defects, including the most minor. However, in 2007, the AHA revised their guidelines to apply to only certain forms of heart disease. Now only children with the highest risk are recommended to use SBE prophylaxis. These include children with
1) a prosthetic heart valve
2) a previous heart infection (endocarditis)
3) cyanotic heart disease that has not been repaired (for example tetralogy of Fallot, transposition of the great arteries, or tricuspid atresia)
4) children who have had any heart surgery during the prior 6 months
5) children who have had heart surgery and have residual defects, especially in the presence of prosthetic surgical material (for example a residual ventricular septal defect following surgical repair of a VSD)
The types of procedures that require antibiotics include any type of dental work where even minimal bleeding may be expected. This does not include procedures such as taking x-rays, adjustment of braces, or losing teeth naturally. In addition, antibiotics are recommended before any type of surgery on potentially infected structures, including removal of the tonsils and adenoids.
Usually the child should take one dose of antibiotic about one hour before the procedure or dental work is going to be performed. The dose of antibiotic is much larger than the typical dose given for a routine infection. The idea is to have the maximum amount of antibiotic circulating in the bloodstream at the time the child may be exposed to bacteria. Further doses after the procedure are no longer necessary under current SBE prophylaxis guidelines.