In an effort to offer clinicians reasonable guidelines for the prevention of infective endocarditis (IE), the American Heart Association (AHA) has published a landmark revision of its widely followed statement on prophylaxis. (1) This tenth version since 1955 considerably decreases the number of conditions for which antimicrobial prophylaxis should be administered prior to bacteremia-producing procedures. The guidelines continue to endorse the rationale for prophylaxis: It is better to prevent IE than to treat established cardiovascular infection; specific cardiac diseases are at greater risk for IE; certain dental, gastrointestinal (GI), and genitourinary (GU) procedures typically cause bacteremia that could lead to IE; and at least in animal models, there is evidence that antibiotics can prevent IE. However, in a major departure from the previous guidelines, it is recognized that no direct evidence in humans indicates that antibiotic prophylaxis is effective. Accordingly, the new guidelines stress the value of excellent...

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