NEW YORK (Reuters Health) — In a marked departure from prior guidelines, new recommendations released by the American Heart Association emphasise that most patients undergoing dental procedures do not need antibiotics to prevent infective endocarditis, a potentially life-threatening infection of the heart."We've concluded that if giving prophylactic antibiotics prior to a dental procedure works at all — and there's no evidence that it does work — we should reserve that preventive treatment only for those people who would have the worst outcomes if they get infective endocarditis. That's a profound change from previous recommendations," Dr. Walter R. Wilson, chair of the writing group, said in a statement.

The new recommendations stem for an analysis of data generated from a MEDLINE search of studies published between 1950 and 2006. In addition, the researchers combed the AHA online library for relevant information.

The guidelines, which appear in the April 20th issue of Circulation, recommend pre-procedure antibiotics for patients with:

[box] an artificial heart valve

[box] prior infective endocarditis

[box] certain congenital heart defects

[box] a cardiac transplant complicated by heart valve dysfunction

However, even if the patient is in a high-risk group, not all dental procedures warrant preventive antibiotics. In particular, they should only be given if the procedure involves manipulation of gum tissue or parts of the teeth.

By contrast, the guidelines emphasise that several indications for antibiotic prophylaxis in past guidelines are no longer relevant, including mitral valve prolapse and rheumatic heart disease, among others.

The guidelines also stress that preventive antibiotics should not be given solely to ward off endocarditis prior to a urinary or gastrointestinal tract procedure.