title: Prophylaxis to prevent infective endocarditis: to use or not to use?
abstract: The American Heart Association (AHA) published their revised guidelines in 2007 in which they markedly limited the recommendations for the use of antimicrobial prophylaxis for the prevention of infective endocarditis (IE), except for patients who are at highest risk of adverse outcomes. A recent focused update on valvular heart diseases changed the recommendation for antibiotic use for patients with many underlying heart conditions including mitral valve prolapse (MVP) which were considered as "low risk" heart defects. In this article, we argue that antibiotic prophylaxis should be considered until concrete clinical evidence is provided to dispute against the use of this strategy, especially for patients with MVP. This approach is cost efficient, and provides a chance to prevent a dreadful disease. We have also enlisted 2 clinical cases to support our argument. These are not uncommon clinical scenarios, and emphasize that IE can be fatal in spite of optimum treatment. Patients have the right to make the final decision, and they should be allowed to participate in choosing for or against this approach until adequate clinical evidence is available.
authors.affiliation: Department of Internal Medicine, Michigan State University, East Lansing, Michigan 48824-1313, USA. Abhijeet.Dhoble@ht.msu.edu
authors.forename: Abhijeet
authors.initials: A
authors.lastname: Dhoble
authors.forename: Ameeth
authors.initials: A
authors.lastname: Vedre
authors.forename: Sahar S
authors.initials: SS
authors.lastname: Abdelmoneim
authors.forename: Srikar Reddy
authors.initials: SR
authors.lastname: Sudini
authors.forename: Amit
authors.initials: A
authors.lastname: Ghose
authors.forename: George S
authors.initials: GS
authors.lastname: Abela
authors.forename: Milind
authors.initials: M
authors.lastname: Karve
mesh_terms: D000572:American Heart Association; D019072:Antibiotic Prophylaxis / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D017548:Echocardiography, Transesophageal; D004696:Endocarditis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D017809:Fatal Outcome; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010353:Patient Education as Topic; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D014081:Tooth Extraction / Q000009:adverse effects*; D016896:Treatment Outcome; D014481:United States
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