In the AHA Guideline by Wilson et al, “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,” that published online on April 19, 2007 (DOI: 10.1161/CIRCULATIONAHA.106.183095), several changes are needed. After online publication of these guidelines, the writing group was made aware that there was confusion among the readership regarding the use of the language “Recommended” in the title of Tables 3 and 4 and “may be reasonable” or “may be considered” in the text when referring to our Class IIb recommendations. The writing group has clarified this by revising the wording in the tables and changing the language in the text to “is reasonable.” According to existing American Heart Association policy for wording of classes of recommendations, this change in language is accompanied by a shift in the class of recommendation from IIb to IIa as detailed in the errata.
1. Since the online publication of this article, the American Academy of Pediatrics and the International Society of Chemotherapy for Infection and Cancer* have added their endorsements.
2. On page 1736, in the footnotes section, the following footnote applies to the endorsement by the International Society of Chemotherapy for Infection and Cancer: “*If these guidelines are applied outside of the United States of America, adaptation of the recommended antibiotic agents may be considered with respect to the regional situation.”
3. On page 1737, in the Conclusions part of the abstract, the following items have been modified: “(2) Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. (3) For patients with these underlying cardiac conditions, prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa.”
4. In Table 3 on page 1745, the following items have been modified:
a. The title now reads: “Cardiac Conditions Associated With the Highest Risk of Adverse Outcome From Endocarditis for Which Prophylaxis With Dental Procedures Is Reasonable”
b. The first entry now reads: “Prosthetic cardiac valve or prosthetic material used for cardiac valve repair”
c. The second footnote now reads: “†Prophylaxis is reasonable because endothelialization of prosthetic material occurs within 6 months after the procedure.”
5. On page 1745, second column, second paragraph, the fifth sentence has been modified to read: “As shown in Table 3, the Committee concludes that prophylaxis is reasonable for dental procedures for these patients during the first 6 months after the procedure.”
6. On page 1745, second column, third paragraph, the last sentence has been modified to read: “In patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE (Table 3), IE prophylaxis for dental procedures is reasonable, even though we acknowledge that its effectiveness is unknown (Class IIa, LOE B).
7. On page 1746, first column, first full paragraph, the third sentence has been modified to read: “Additionally, the change in emphasis to restrict prophylaxis for only those patients with the highest risk of adverse outcome should reduce the uncertainties among patients and providers about who should receive….”
8. On page 1746, first column, the section heading has been modified from “Regimens Recommended” to “Antibiotic Regimens.”
9. On page 1746, first column, fourth paragraph, the fourth and fifth sentences have been modified to read: “Therefore, antibiotic prophylaxis is reasonable for patients with the conditions listed in Table 3 who undergo any dental procedure that involves the gingival tissues or periapical region of a tooth and for those procedures that perforate the oral mucosa (Table 4). Although IE prophylaxis is reasonable for these patients, its effectiveness is unknown (Class IIa, LOE C).”
10. For Table 4 on page 1746, the title has been changed to: “Dental Procedures for Which Endocarditis Prophylaxis Is Reasonable for Patients in Table 3.”
11. On page 1747, second column, under the “Regimens for Respiratory Tract Procedures” heading, the second sentence has been modified to read: “Antibiotic prophylaxis with a regimen listed in Table 5 is reasonable (Class IIa, LOE C) for patients with the conditions listed in Table 3 who undergo an invasive procedure of the respiratory tract that involves incision or biopsy of the respiratory mucosa, such as tonsillectomy and adenoidectomy.”
12. In Table 6 on page 1748, the following items have been updated:
a. The sixth entry should read: “Antibiotic prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissues….”
b. The seventh entry should read: “Antibiotic prophylaxis is reasonable for procedures on respiratory tract or infected skin, skin structures, or musculoskeletal….”
c. The last entry should read: “Although these guidelines recommend changes in indications for IE prophylaxis with regard to selected dental procedures (see text), the writing group reaffirms that those medical procedures listed as not requiring IE prophylaxis in the 1997 statement remain unchanged and extends this view to vaginal delivery and hysterectomy and tattooing. Additionally, the committee advises against body piercing for patients in Table 3 because of the possibility of bacteremia, while recognizing there are minimal published data regarding the risk of bacteremia or endocarditis associated with body piercing.”
13. On page 1748, second column, the heading at the top of the column has been modified to read: “Regimens for Procedures on Infected Skin, Skin Structure, or Musculoskeletal Tissue”.
14. On page 1748, second column, first paragraph, the second sentence has been modified to read: “For patients with the conditions listed in Table 3 who undergo a surgical procedure that involves infected skin, skin structure, or musculoskeletal tissue, it may be reasonable that the therapeutic regimen administered for treatment of the infection contain an agent active against staphylococci….”
15. On page 1749, first column, last paragraph, the last sentence has been modified to read: “In hospitals with a high prevalence of methicillin-resistant strains of S epidermidis, surgical prophylaxis with vancomycin may be reasonable but has not been shown to be superior to prophylaxis….”
16. On page 1749, second column, under the heading “Other Considerations”, the penultimate sentence has been modified to read: “Accordingly, the use of IE prophylaxis for dental procedures in cardiac transplant recipients who develop cardiac valvulopathy is reasonable, but the usefulness is not well established (Class IIa, LOE C; Table 4).”
These changes have been made in the current print (Circulation. 2007;116:1736–1754) and online versions of the article.