This Italian consensus document supports contemporary guidelines that downgrade the indications for antibiotic prophylaxis in infective endocarditis, reserving it for patients at high risk of a complicated prognosis.
Supports limiting prophylaxis to high-risk patients; reinforces contemporary guideline downgrades.
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. CONCLUSION: 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.
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Cecchi et al. (2010) conducted a review in Infective endocarditis. Antibiotic prophylaxis was evaluated. An Italian consensus concluded that antibiotic prophylaxis for infective endocarditis is based on weak evidence and should be reserved for patients at high risk of a complicated prognosis.
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