**3. Current antibiotic protocols**

Antibiotic prophylaxis protocols against IE have undergone relevant changes in recent years. There is no doubt that the categorical 2008 NICE recommendations and their implementation in their area of influence constitute an event with significant epidemiological repercussions that will serve to evaluate the efficacy of antibiotic prophylaxis for the prevention of IE. The scientific societies responsible for this question continue detailed follow-up in order to incorporate their conclusions as relevant data arise.

Among the different prophylaxis guidelines proposed by expert committees around the world, those that represent their corresponding geographical areas stand out for their scientific relevance. In the USA, the AHA has been pioneer in the introduction of antibiotic prophylaxis against IE; its most recent guideline was published in 2007 [11]. In Australia, the Infective Endocarditis Prophylaxis Expert Group (AIEPEG) published a guideline in 2008 that has been supported by the principal health associations in its area of influence [12]. In Europe, the ESC published the 2015 review of its protocols in the European Heart Journal, stating the official position of that scientific society on this subject [13]. These three guidelines coincide on two major points:

**•** All propose amoxicillin as the antibiotic of choice.

endocarditis 10 days after undergoing a dental procedure without antibiotic prophylaxis, following the NICE recommendations. The dental history of the patient showed that he had received antibiotic prophylaxis during dental sessions over the previous 10 years with no

The most recent epidemiological studies have identified a significant increase in the incidence of IE after implementation of the NICE guideline. A retrospective study was performed in England to investigate the effect of antibiotic prophylaxis versus no prophylaxis on the incidence of IE [9]. The data collected and the subsequent analysis suggested that after March 2008—the year of publication of the NICE guideline—the number of cases of IE increased

According to some experts, these data are mainly observational and do not prove that the lower level of antibiotic prophylaxis was the cause of the increase in IE. However, no other satisfac-

Despite this, NICE has reviewed all evidence relating to the effectiveness of IE prophylaxis as a precaution but, at present, they have found no need to change any of the existing 2008 guideline. They have, however, made an additional research recommendations on antibiotic

To provide a cohort of patients able to generate sufficient evidence from well-

To use a population-based cohort study design to allow direct comparison between acquired heart valve disease and structural congenital heart disease to estimate

To determine the frequency and intensity of bacteraemia caused by non-oral daily

A randomised controlled trial with long-term follow-up comparing antibiotic prophylaxis with no antibiotic prophylaxis in adults and children with underlying

structural heart defects undergoing interventional procedures

*Note*: https://nice.org.uk/guidance/CG64/chapter/Recommendations-for-research#4-antibiotic-prophylaxis-against-

**Table 1.** NICE recommendations for research. Antimicrobial prophylaxis against infective endocarditis in adults and

Antibiotic prophylaxis protocols against IE have undergone relevant changes in recent years. There is no doubt that the categorical 2008 NICE recommendations and their implementation in their area of influence constitute an event with significant epidemiological repercussions

tory explanation for this increase in the incidence of IE has yet been put forward [10].

conducted national studies

relative and absolute IE risk

activities

children undergoing interventional procedures (updated in 2015).

**3. Current antibiotic protocols**

adverse outcomes [8].

18 Contemporary Challenges in Endocarditis

significantly above the expected historical trend.

prophylaxis against IE as summarised in **Table 1**.

**Field of research Importance**

1. National register of infective

3. Interventional procedures and

4. Antibiotic prophylaxis against

2. Cardiac conditions and infective endocarditis

infective endocarditis

infective endocarditis

infective-endocarditis

endocarditis

**•** All propose clindamycin as the alternative antibiotic of choice to amoxicillin.
