General measures to prevent infective endocarditis

Data to support antibiotic prophylaxis are limited, and many cases of infective endocarditis are not preceded by a procedure. Therefore, general preventive strategies and early recognition and treatment of infective endocarditis are important.

All people, but particularly those with cardiac abnormalities, should practise good oral hygiene and have regular dental check-ups, with preventive dental and periodontal treatment to ensure optimal oral health.

For people with a cardiac condition listed here or any form of native valve disease, the following preventive strategies are recommended:

• twice-yearly dental examination and scaling
• timely treatment of all bacterial infections, particularly those caused by Staphylococcus aureus or streptococci
• avoidance of intravascular catheters and invasive procedures, unless necessary
• strict adherence to protocols for managing central and peripheral intravenous devices (eg ‘care bundles’)
• active discouragement of tattooing, piercing (particularly tongue piercing) and intravenous drug use.

Investigate an unexplained fever in patients with a cardiac condition listed here, because it could be a sign of infective endocarditis—see Assessment of infective endocarditis. Blood samples should be taken for culture before the administration of antibiotics.