Antibiotics in Heart Failure: A Narrative Review

Infections commonly cause acute decompensation and poor outcomes in heart failure (HF), a major global health burden. Patients with heart failure are particularly vulnerable to infections related to the respiratory, urinary, skin, and devices because of systemic inflammation, immune dysfunction, changes in the gut barrier, and repeated exposure to healthcare facilities. The use of empirical antibiotics without confirmation due to overlapping symptoms between infection and heart failure is frequently associated with extended hospital stays, drug toxicity, and antibiotic resistance. While early targeted therapy improves outcomes in confirmed infections, evidence points to limited benefit and possible harm from unnecessary antibiotics. To maximize management in this susceptible population, careful diagnostic evaluation, stewardship, and customized prescribing are crucial.