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FOCUS ISSUE: VALVULAR HEART DISEASE: VIEWPOINT

Perspectives on the American College of Cardiology/American Heart Association Guidelines for the Prevention of Infective Endocarditis

Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan

Manuscript received August 13, 2008; accepted September 10, 2008.

^_* Reprint requests and correspondence: Dr. David S. Bach, CVC Room 2147, SPC 5853, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-5853 (Email: dbach{at}umich.edu).

In 2007, the American Heart Association published a guideline statement dramatically changing its previous position on the use of antibiotic prophylaxis in patients at risk of infective endocarditis (IE). This year, these views were incorporated in an update of the 2006 American College of Cardiology/American Heart Association Guidelines for the Management of Patients With Valvular Heart Disease. The new recommendations represent a dramatic shift with regard to which patients should receive antibiotic prophylaxis for prevention of IE and for what procedures. The shift in recommendations is striking in that the recommendations are based not on new data, but on no data. (There are no large, prospective, randomized double-blind trials testing the efficacy of IE prophylaxis.) However, available data suggest that there may be no real risk associated with IE prophylaxis. Even if few cases of IE are successfully prevented using antibiotic prophylaxis, those few cases may represent a favorable risk-benefit ratio. On an individual basis, patients with organic heart valve disease who are trying to delay or avoid surgical intervention have something very real to risk if they develop IE, and a very real benefit if they avoid it. Pending data from prospective randomized trials, a strategy of individual decision-making by informed patients may be best.

Key Words: infective endocarditis • prophylaxis • antibiotics • guidelines • prevention

Abbreviations and Acronyms   ACC = American College of Cardiology   AHA = American Heart Association   GI = gastrointestinal   GU = genitourinary   IE = infective endocarditis

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