Interactive clinical case: to give, or not to give, infective endocarditis prophylaxis

The practice of prophylactic use of antibiotics before certain procedures for preventing infective endocarditis (IE) is not based on rigorous scientific data. It seems reasonable, however, to offer prophylactic antibiotics before dental procedures to patients who would have the highest risk of adverse events if they were to develop IE. The current recommendations do not include patients with rheumatic heart disease (RHD) in such a category. In the real world, however, patients with underlying RHD suffer high morbidity and mortality with IE due to several reasons. Consequently, prophylactic antibiotics should be used judiciously in patients with RHD. Further, other patient related factors might influence the decision to use antibiotics.