We concluded that only an extremely small number of cases of IE might be prevented by antibiotic prophylaxis even if prophylaxis is 100% effective. Antibiotic prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of IE. Limit recommendations for IE prophylaxis only to those conditions listed in Table 3. Antibiotic prophylaxis is no longer recommended for any other form of CHD, except for the conditions listed in Table 3. Antibiotic prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissues or periapical region of teeth or perforation of oral mucosa only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE (Table 3). Antibiotic prophylaxis is reasonable for procedures on respiratory tract or infected skin, skin structures, or musculoskeletal tissue only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE (Table 3). Antibiotic prophylaxis solely to prevent IE is not recommended for GU or GI tract procedures. 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, hysterectomy, and tattooing. Additionally, the committee advises against body piercing for patients with conditions listed in Table 3 because of the possibility of bacteremia, while recognizing that there are minimal published data regarding the risk of bacteremia or endocarditis associated with body piercing. penicillin for secondary prevention of rheumatic fever or for other purposes are likely to have viridans group streptococci in their oral cavity that are relatively resistant to penicillin or amoxicillin. 