Recommendations on prophylaxis for infective endocarditis: dramatic changes over the past seven years.

Recommendations on antibiotic prophylaxis against infective endocarditis have changed dramatically since 2002. In 2002, the French were the first to make a profound change: they proposed that antibiotic prophylaxis should be optional when a medical, surgical or dental procedure that carries a risk of infective endocarditis was performed in a patient at risk but not at very high risk of infective endocarditis (group B: native valve disease, non-cyanotic congenital heart disease, obstructive hypertrophic cardiomyopathy). In 2004, the European Society of Cardiology and the British Society of Cardiology made almost no changes to their previous recommendations. In 2006, the British Society for Antimicrobial Chemotherapy made another radical change: no antibiotic prophylaxis in group B patients. In 2007, the American Heart Association went a step further: no antibiotic prophylaxis before a gastrointestinal or genitourinary procedure in group A patients (valvular prosthesis, cyanotic congenital heart disease, history of infective endocarditis). In 2008, the British National Institute for Health and Clinical Excellence adopted an extreme position: no antibiotic prophylaxis at all in patients at risk for infective endocarditis.