Infective endocarditis prophylaxis: a review

Guidelines for prophylaxis against infective endocarditis (IE) have changed significantly due to a lack of evidence for its efficacy and increasing concerns about safety and antibiotic resistance. The impact of these changes on clinical practice and IE hospitalisation trends and outcomes has become a focus of research. Areas covered: We review the rationale for and against IE prophylaxis, highlight significant changes in guidelines since 2002, and discuss literature examining the impact of these changes on antibiotic prescription rates for IE prophylaxis, IE incidence, morbidity, and mortality. We included English articles published since 2002 relevant to IE prophylaxis. Expert commentary: Existing guidelines recommend limited to no prophylaxis against IE but differ on which patient populations would benefit most. Antibiotic prescription rates for IE prophylaxis have declined as a result of newer restrictive guidelines, most significantly in the UK where IE prophylaxis is not recommended. However, conflicting data exists on the impact of these changes on the trends of IE hospitalisation and clinical outcomes. Definitive studies to resolve this controversy do not seem feasible in the near future but well designed prospective observational studies may provide novel information on the long term impact of the new guidelines.