title: Infective endocarditis prophylaxis: current practice trend among paediatric cardiologists: are we following the 2007 guidelines?
abstract: BACKGROUND
  In 2007, the American Heart Association modified the infective endocarditis prophylaxis guidelines by limiting the use of antibiotics in patients with cardiac conditions associated with the highest risk of adverse outcomes after infective endocarditis. Our objective was to evaluate current practice for infective endocarditis prophylaxis among paediatric cardiologists.
  
  
  METHODS
  A web-based survey focussing on current practice, describing the use of antibiotics for infective endocarditis prophylaxis in various congenital and acquired heart diseases, was distributed via e-mail to paediatric cardiologists. The survey was kept anonymous and was distributed twice.
  
  
  RESULTS
  Data from 253 participants were analysed. Most paediatric cardiologists discontinued infective endocarditis prophylaxis in patients with simple lesions such as small ventricular septal defect, patent ductus arteriosus, and bicuspid aortic valve without stenosis or regurgitation; however, significant disagreement persists in prescribing infective endocarditis prophylaxis in certain conditions such as rheumatic heart disease, Fontan palliation without fenestration, and the Ross procedure. Use of antibiotic prophylaxis in certain selected conditions for which infective endocarditis prophylaxis has been indicated as per the current guidelines varies from 44 to 83%. Only 44% follow the current guidelines exclusively, and 34% regularly discuss the importance of oral hygiene with their patients at risk for infective endocarditis.
  
  
  CONCLUSIONS
  Significant heterogeneity still persists in recommending infective endocarditis prophylaxis for several cardiac lesions among paediatric cardiologists. More than half of the participants (56%) do not follow the current guidelines exclusively in their practice. Counselling for optimal oral health in patients at risk for infective endocarditis needs to be optimised in the current practice.
authors.affiliation: 1Department of Pediatrics,The University of Tennessee Health Science Center and Le Bonheur Children's Hospital,Memphis,Tennessee,United States of America.
authors.forename: Ronak J
authors.initials: RJ
authors.lastname: Naik
authors.affiliation: 2Icahn School of Medicine at Mount Sinai,Center for Advanced Medicine,New York,New York,United States of America.
authors.forename: Neil R
authors.initials: NR
authors.lastname: Patel
authors.affiliation: 3Department of Public Health Sciences,Penn State College of Medicine,Hershey,Pennsylvania,United States of America.
authors.forename: Ming
authors.initials: M
authors.lastname: Wang
authors.affiliation: 4Department of Pediatrics,Penn State Hershey Medical Center,Penn State College of Medicine,Hershey,Pennsylvania,United States of America.
authors.forename: Nishant C
authors.identifier: http://orcid.org/0000-0002-2148-3799
authors.initials: NC
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000572:American Heart Association; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000639:trends*; D000072096:Cardiologists / Q000706:statistics & numerical data*; D002309:Cardiology; D002648:Child; D002675:Child, Preschool; D034742:Electronic Mail; D004696:Endocarditis / Q000517:prevention & control*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Infective endocarditis; congenital heart disease; paediatric cardiology