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Endokarditisprophylaxe: Was hat sich geändert?

Antimicrobial Prophylaxis to Prevent Endocarditis: What Has Changed?

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Zusammenfassung

Die American Heart Association hat 2007 die bis dahin relativ einheitlichen Leitlinien zur Endokarditisprophylaxe im Gefolge zahnärztlicher Eingriffe radikal in Frage gestellt. Diesem nicht unwidersprochenen Paradigmenwechsel liegen keine neuen Studienergebnisse zugrunde, sondern er erfolgte aufgrund einer Neuinterpretation lange bekannter Daten. Für die Mehrzahl der Patienten, die bisher eine Prophylaxe erhielten (insbesondere Patienten mit degenerativen und rheumatischen Herzklappenfehlern) wird nunmehr eine Endokarditisprophylaxe aus Kosten-Nutzen-Risiko-Erwägungen nicht länger empfohlen. Für Patientengruppen mit sehr hohem Lebenszeitrisiko, an einer mikrobiellen Endokarditis zu erkranken, oder mit erwartet kompliziertem Erkrankungsausgang (z.B. Kunstklappenträger, konservativ sanierte Endokarditis, bestimmte angeborene Herzfehler) wird eine Prophylaxe weiterhin für erforderlich gehalten. Das hierzu publizierte deutsche Positionspapier (S2-Leitlinie) eröffnet demgegenüber die Möglichkeit einer individuellen Vereinbarung zwischen betroffenem Patienten und behandelndem Arzt, was sich insbesondere für Patienten, die seit vielen Jahren eine Endokarditisprophylaxe betreiben, als hilfreich erwiesen hat.

Abstract

The American Heart Association (AHA) radically changed the recommendations regarding endocarditis prophylaxis, if patients undergo dental work. For the vast majority of patients previously considered to be at significant risk for bacterial endocarditis (especially patients with degenerative and rheumatic heart disease), routine endocarditis prophylaxis is not longer recommended from a cost-benefit-risk standpoint. Only patient populations with a very high lifetime risk for bacterial endocarditis or an expected worse outcome (patients with prosthetic heart valves, conservatively treated endocarditis, and certain groups with congenital heart disease) are judged candidates for endocarditis prophylaxis. In 2007, a German position paper (S2 guideline) comments the AHA recommendations. This position paper allows a more individual approach, if treating physician and patient agree upon the benefit of endocarditis prophylaxis in the individual case.

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Authors and Affiliations

  1. Kardiologische Klinik, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany

    Cornelia Piper

  2. Direktor der Kardiologischen Klinik, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany

    Dieter Horstkotte

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  1. Dieter Horstkotte
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  2. Cornelia Piper
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Correspondence to Dieter Horstkotte.

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Horstkotte, D., Piper, C. Endokarditisprophylaxe: Was hat sich geändert?. Herz 34, 64–68 (2009). https://doi.org/10.1007/s00059-009-3208-7

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