Infective endocarditis, the conundrum of antibiotic prophylaxis

Infective endocarditis (I.E.) is a common bacterial infection of the endocardium, which before the advent of antibiotics, had a high mortality rate. Endocarditis has been described as a serious and a potentially fatal condition in which the heart beats in a muffled march towards the grave, in quick time in the acute form and with a slower, but as deadly rhythm, in the subacute form. I.E. can occur at any period of life, but presently, there has been a shift towards younger individuals due to intravenous drug abuse. Thus the overall incidence since the pre-antibiotic era has remained constant. This has been the situation in spite of the periodic revisions made by the American Heart Association (AHA) for the guidelines for antibiotic prophylaxis. In India there are no guidelines issued by any professional organisations and hence the decision to use antibiotic prophylaxis depends on the dentist's awareness of the patient's predisposition, the standard regime learnt from a textbook, the patient's economic status and belief to comply with the advice and the choice of antibiotic, route of administration and dose. In this paper, an attempt is made to collect data on the incidence of I.E. from two large teaching hospitals and use it to decide whether antibiotic prophylaxis of patients predisposed to I.E. should be followed or not.