Which scenario warrants antibiotic prophylaxis for infective endocarditis?

• A. Routine dental cleaning with no gingival manipulation
• B. Prosthetic cardiac valve or prior endocarditis
• C. Simple sore throat without fever
• D. Uncomplicated asthma

Answer: (B)

Antibiotic prophylaxis for endocarditis is reserved for people at high risk of severe outcomes who are about to undergo procedures that can introduce oral bacteria into the bloodstream. The key high-risk group includes individuals with prosthetic cardiac valves or a history of endocarditis. For these patients, prophylaxis is given before dental procedures that involve manipulation of the gingival tissue or perforation of the oral mucosa, because such procedures can cause bacteremia and potentially seed a prosthetic valve or damaged heart tissue. Routine dental cleaning without gingival bleeding is not typically an indication for prophylaxis, and a simple sore throat or uncomplicated asthma does not involve a procedure that would necessitate antibiotic protection. If prophylaxis is used, a common approach in adults is amoxicillin 2 g taken orally about 30 to 60 minutes before the procedure, with alternatives available for penicillin-allergic individuals.