Key Points

1. Guidelines exist for antibiotic prophylaxis against infective endocarditis (IE). There is little robust clinical evidence supporting proof that antibiotic prophylaxis decreases the immediate subsequent risk for IE. The strength of the evidence rests on animal studies, which may or may not accurately reflect human disease, as well as on expert opinion. Nonetheless, a priori algorithms have been proposed for the health-care practitioner, based on patient risk factors for disease as well as the likelihood of bacteremia from a given procedure.

2. The mechanism(s) by which antibiotics affect prophylaxis remain unclear, but may involve interfering with bacterial adherence to a fib-rinous valvular vegetation and/or clearance of pathogen after such adherence.

3. Current recommendations provide both oral and intravenous regimens, the latter for patients unable to take medication orally. There is no evidence for superiority of one regimen over the other. The recommendations also provide alternatives for patients with a history of allergy to P-lactams. The suggested regimens may decrease but will not eliminate the risk of IE.

4. Given that the microbiology and the antimicrobial resistance patterns of the most common pathogens causing IE are evolving, guidelines will need to be regularly revised.

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