Use of prophylactic antibiotics in the prevention of infective endocarditis and prosthesis infection.

In the field of antimicrobial therapy, few areas have created more debate and controversy than the subject of antibiotic prophylaxis for infective endocarditis. Firstly, there still exists considerable controversy about the efficacy of prophylactic antibiotics for prevention of bacterial endocarditis. Secondly, dental surgeons, orthopaedic surgeons, cardiologists and endoscopists have differing opinions regarding indications for pre-procedural prophylactic antibiotics against infective endocarditis. The British have a different set of recommendations from the Americans although the basic tenets on which these recommendations are founded are similar. This article summarises the updated recommendations issued by the American Heart Association (AHA) as well as those from the British Society for Antimicrobial Chemotherapy. A short discussion of the use of prophylactic antibiotics prior to endoscopy and surgery for patients with non-valvular prosthetic devices has been included in this paper. Practitioners should also be reminded that these recommendations are issued as guidelines and clinical judgement must be exercised when dealing with individual patients.