Matters of the heart; antibiotic prophylaxis for prevention of infective endocarditis—are we getting it right?

Sperotto F, France K, Gobbo M et al. Antibiotic prophylaxis and infective endocarditis incidence following invasive dental procedures: a systematic review and meta-analysis. JAMA Cardiol 2024; 9:599. https://doi.org/10.1001/jamacardio.2024.0873 . This systematic review evaluates the association between antibiotic prophylaxis (AP) and the incidence of infective endocarditis (IE) following invasive dental procedures (IDPs). A systematic search was conducted across PubMed, Cochrane-CENTRAL, Scopus, Web of Science, Proquest, and Embase, from inception to May 2023. Observational studies, including case-control, case-crossover, cohort, self-controlled case-series, and time-trend studies were included. Data were extracted independently, and structured tools were used to evaluate study quality. A random-effects meta-analysis estimated the pooled-relative risk (RR) of developing IE in high-risk subjects who received AP compared to those who did not. Of 11,217 identified records, 30 studies met inclusion criteria, comprising 1,152,345 IE cases. Among 12 relevant studies, five found a significant protective effect of AP in high-risk subjects. Four studies were combined in meta-analysis and showed AP was associated with a significantly lower IE risk in high-risk individuals (pooled-RR = 0.41, 95% CI: 0.29-0.57). No significant association was found for moderate- or low/unknown-risk subjects. Time-trend studies showed mixed results: some indicated increased IE incidence after AP guideline changes, while others found no change or a decrease. Despite limitations, this review provides an important update on AP use in preventing IE after IDPs. Evidence supports AP use for high-risk individuals, while data remain inconclusive for moderate-risk populations, highlighting the need for further research.