Antibiotic prophylaxis of infective endocarditis

Links between infective endocarditis (IE) and den-tal and other invasive procedures were first identified in the1920s, and the use of antibiotic prophylaxis (AP) to prevent IEwas first recommended by the American Heart Association in1955. Recognising the weak evidence to support this practiceand the wider risks of anaphylaxis and antibiotic resistance,guidelines in the USA and Europe have been rationalised inthe last decade with restriction of AP to those patients per-ceived to be at the highest risk. In the UK, the NationalInstitute for Health and Care Excellence controversially rec-ommended the complete cessation of AP for all invasive pro-cedures in 2008 and subsequent epidemiological studies havesuggested a significant increase in cases above the baselinetrend. AP appears to be safe and is likely to be cost-effective.Until further data are available, we recommend continued ad-herence to US and European guidelines.