Infective endocarditis and the new AHA guideline.

Infective endocarditis (IE) is becoming a disease of the elderly because of the aging process and increased use of intravascular devices. If undetected, IE has a poor prognosis. Previous guidelines had become cumbersome, and with unintended consequences, ie, excess antibiotic use, potential risk for acquisition of multiple-drug-resistant organisms and adverse drug reactions. The newest American Heart Association guideline severely restricts antibiotic prophylaxis, recommending it only for cardiac conditions with the greatest risks for complications and for dental procedures that involve perforation of oral mucosa, manipulation of gingival tissue or periapical region of the teeth. Routine prophylaxis for genitourinary and gastrointestinal procedures is no longer recommended.