ABSTRACT
Despite the availability of antibiotics, the incidence of infective endocarditis (IE) has not decreased. It has actually increased in certain populations (nosocomial/ healthcare-associated IE) (1). Realization of this relative failure of traditional antibiotic prophylaxis is a compelling argument to re-examine our approach in preventing valvular infections. A pragmatic starting point would be to understand the types of IE that we are currently able to prevent and the potential benefits and risks for doing so. The goal of this chapter is to critically appraise the current recommendations for prevention of IE and to suggest how the practitioner may be able to appropriately modify them for a specific patient. The numerous guidelines, which have been developed by the American Heart Association (AHA) (2) and others over the years (3,3a), had never been intended to be strict rules or clinical pathways. Their intent has been to direct the reader to those cardiac conditions that require anti microbial prophylaxis, to identify those invasive procedures that present a real risk to these patients, and to make suggestions concerning the appropriate dosage regimens of various antibiotics that are used to prevent valvular infection. They are “… not intended as a standard of care or as a substitute for clinical judgment” (2). Because of their infrequent issue, they cannot remain current with the changing epidemiology of the disease.
