A probabilistic model analyzes the American Heart Association's (AHA) recommendations for the prevention of infective endocarditis (IE) of dental origin. The model, presented in the form of a flow chart, combines available data elements with the AHA recommendations; mortality serves as the sole valued outcome and payoff measure. The analysis shows that an annual death rate of 1.36 per million population is attributable to the antibiotics administered in an attempt to prevent IE, whereas not more than 0.26 annual deaths per million are traceable to IE of dental origin. Sensitivity and threshold analyses were conducted to determine the conditions under which the recommended prophylactic policy will prove beneficial. The model suggests that the standard AHA antibiotic regimen should be exploited only in IE susceptible patients belonging to the high risk categories and that its value in moderate, low, and negligible risk patients is doubtful. When the use of antibiotics is unavoidable, oral administration is the preferable route.
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