Prophylaxis against infective endocarditis

The purpose of this review is to discuss current international guidelines on the prevention of infective endocarditis (IE). It has long been considered that all patients with heart conditions predisposing to IE should receive antibiotic prophylaxis when undergoing procedures leading to bacteremia with organisms known to cause endocarditis. However, evidence for this is poor and based on isolated case reports, and on theoretical considerations, rather than on randomized controlled trials. Recently, thinking has changed for 3 main reasons. Firstly, there is now strong evidence that bacteremia with endocarditis-causing organisms frequently occurs following everyday activities, such as tooth-brushing. Secondly, few cases of endocarditis are directly attributable to a preceding procedure. Thirdly, adverse effects of antibiotic use should be given due consideration. Recent international guidelines have radically changed recommendations on this issue, advocating limited, or non-use of antibiotics in a very small group of high-risk individuals for a limited number of invasive procedures.