Pre-medication of medical-risk patients for dental procedures

The necessity to provide prophylactic antibiotic cover to avoid infective endocarditis for patients receiving dental treatment leads, on occasions, to confusion and is frequently the subject of questions at postgraduate meetings. There are several medical conditions which have in the past been considered to require prophylaxis which are no longer considered indications for such therapy. However, a definitive list of conditions necessitating antibiotic cover has been agreed (Table 1). There are several different schedules of prophylaxis which may be used in different circumstances. This paper seeks to identify the main features of infective endocarditis and current prophylactic schedules accepted in the United Kingdom. Figure 1 outlines, in the form of a flow-diagram, the decision making process involved in choosing the most appropriate schedule. This flow-diagram may act as a 'quick-reference' for use in the surgery.