[A revolutionary change in the recommendations for antimicrobial prophylaxis of infective endocarditis (ie)]

Prophylactic use of antibiotics to prevent infective endocarditis (IE) used to be a part of the routine care of patients with almost any type of cardiac abnormality for more than 50 years. However, in the absence of placebo-controlled, randomized, double-blinded studies to evaluate its efficacy, doubts have been raised concerning its utility. It was recently concluded that IE is much more likely to result from frequent exposure to random bacteremias associated with daily activities than from bacteremias caused by invasive medical procedures; that only a small number of cases of IE are caused by bacteremia that follows dental procedure; and that prophylaxis may prevent an extremely small number of cases of IE. This led the American Heart Association (AHA) to initiate substantial changes in the recommendations for prophylaxis, the main points of which are as follows: 1. Good oral hygiene and eradicating dental disease is the most important tool for preventing IE. 2. Antibiotic prophylaxis should be limited only to patients at high risk for complications and mortality from IE. 3. Prophylaxis for GI or GU tract procedures is no longer recommended. It is most likely that this remarkable change in the guidelines will provoke a debate in the medical literature; moreover, for the first time, this change allows performing placebo-controlled, randomized, double-blinded studies to evaluate the efficacy of antibiotic prophylaxis of IE.