title: The prophylaxis of infective endocarditis: a joint position study of the Italian Federation of Cardiologists and the Italian Society of Infectious and Tropical Diseases.
abstract: BACKGROUND
  Antibiotic prophylaxis of patients believed to be at a risk of developing infective endocarditis has been recently revisited with limited indications compared with the previous body of knowledge in use by the medical community. As a consequence, most of the healthcare specialists in cardiology and infectious diseases have doubts related to the enormous change that has been proposed. In this study, we report the results of an Italian consensus of experts in cardiology and infectious diseases, with the aim to offer a national document that illustrates the reasons for such a change through the review of the basis of infective endocarditis prophylaxis, the historical background, and the reasons for the change, providing practical conclusions and illustrating grey areas.
  
  
  METHODS
  The main guidelines published on the topic of antibiotic prophylaxis for infective endocarditis were discussed as well as the risk of anaphylaxis. Overall, the group agreed that the evidence for prophylaxis is weak and limited to few case-control studies, expert opinion, clinical experience, and descriptive studies.
  
  
  RESULTS
  The 'downgrading' of the indications for prophylaxis is mainly due to a cultural change and a more critical attitude towards available published data. Although the group acknowledge the critical view of the previously published guidelines, it seems to be more practical to consider the issue of prophylaxis without the evidence required by guidelines but rather as a consensus document based on the available data.
  
  
  CONCLUSIONS
  Contemporary guidelines on infective endocarditis prophylaxis challenge previous recommendations based on a low level of evidence. The main recommendation of the study group is to underline that prophylaxis may often be based on adequate education without the administration of antibiotics, which only remains suggested, following the usual practice, in patients with heart diseases, when the risk of a complicated prognosis following infective endocarditis may be anticipated.
authors.affiliation: Ospedale Maria Vittoria di Torino, Italy. cecchi.enrico@tin.it <cecchi.enrico@tin.it>
authors.forename: Enrico
authors.initials: E
authors.lastname: Cecchi
authors.forename: Francesco G
authors.initials: FG
authors.lastname: De Rosa
authors.forename: Fabio
authors.initials: F
authors.lastname: Chirillo
authors.forename: Enzo
authors.initials: E
authors.lastname: Petrelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Oreto
authors.forename: Fredy
authors.initials: F
authors.lastname: Suter
authors.forename: Rocco
authors.initials: R
authors.lastname: Lagioia
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Viale
authors.forename: Francesco
authors.initials: F
authors.lastname: Enia
authors.forename: Matteo
authors.initials: M
authors.lastname: Bassetti
authors.forename: Mario
authors.initials: M
authors.lastname: Venditti
authors.forename: Nicola
authors.initials: N
authors.lastname: Petrosillo
authors.forename: Riccardo
authors.initials: R
authors.lastname: Utili
authors.forename: Massimo
authors.initials: M
authors.lastname: Imazio
authors.forename: Rita
authors.initials: R
authors.lastname: Trinchero
mesh_terms: D019072:Antibiotic Prophylaxis / Q000592:standards*; D002309:Cardiology / Q000639:trends*; D004697:Endocarditis, Bacterial / Q000517:prevention & control*; D006801:Humans; D007558:Italy; D017410:Practice Guidelines as Topic; D012306:Risk; D012955:Societies, Medical; D035501:Uncertainty