Patients with a history of rheumatic fever are considered at increased risk of developing infective endocarditis due to potential acquired valvular heart disease resulting from rheumatic carditis. However, current UK guidelines do not recommend routine antibiotic prophylaxis solely based on a history of rheumatic fever for dental or other interventional procedures. Instead, prophylaxis is reserved for those with specific high-risk cardiac conditions such as previous infective endocarditis, prosthetic heart valves, or certain structural heart defects NICE CG64.
UK guidance emphasizes that antibiotic prophylaxis against infective endocarditis is not routinely recommended for dental or non-dental procedures in people with acquired valvular heart disease, including those with rheumatic heart disease, unless they have had previous infective endocarditis or other high-risk features NICE CG64. Instead, the focus is on maintaining good oral hygiene and prompt treatment of infections to reduce endocarditis risk NICE CG64.
In contrast, American Heart Association (AHA) guidelines, which are influential internationally, recommend antibiotic prophylaxis for patients with rheumatic heart disease who have residual valvular damage, particularly if they are undergoing dental procedures that involve manipulation of gingival tissue or the periapical region of teeth, or perforation of oral mucosa Wilson et al. 2007. This reflects a more conservative approach to prophylaxis in this population Wilson et al. 2007.
Therefore, in the UK context, patients with a history of rheumatic fever but without previous infective endocarditis or prosthetic valves are generally not given routine antibiotic prophylaxis before procedures. Instead, they should be informed about the importance of oral health and infection prevention NICE CG64. If they undergo procedures where infection is suspected, appropriate antibiotic therapy covering endocarditis-causing organisms should be used NICE CG64.
Key References
- CG64 - Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures
- CKS - Sickle cell disease
- CKS - Diarrhoea - prevention and advice for travellers
- CKS - Sore throat - acute
- CKS - Scarlet fever
- NG208 - Heart valve disease presenting in adults: investigation and management
- NG196 - Atrial fibrillation: diagnosis and management
- (Wilson et al., 2007): 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.
- (Gerber et al., 2009): Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics.
- (Thornhill et al., 2017): Antibiotic Prophylaxis of Infective Endocarditis.