Can we really do without antibiotic prophylaxis for infective endocarditis?

Current guidance recommends against the use of antibiotic prophylaxis around the time of dental intervention for the prevention of infective endocarditis. The authors report the case of a previously well-patient with an asymptomatic isolated ventricular septal defect (VSD) who developed evidence of infective systemic and pulmonary emboli following dental treatment. A diagnosis of severe endocarditis of a previously normal native mitral valve was made. She subsequently underwent surgical repair of her mitral valve, and closure of her VSD. She was deemed fit for discharge on parenteral antibiotics on the thirtieth postoperative day. The authors highlight the need for further re-evaluation of the issues surrounding antibiotic prophylaxis for endocarditis in the context of dental procedures.