Systematic Review on the Prophylactic Use of Antibiotics for Preventing Infective Endocarditis

Abstract

Introduction:

Infective endocarditis, a life-threatening infection, occurs in approximately 5-10 individuals per 100,000 each year. The prevention of this condition through the use of antibiotic prophylaxis is crucial. Yet, the effectiveness of antibiotic prophylaxis in preventing infective endocarditis is a topic of debate due to the lack of conclusive proof supporting its efficacy.

Methods:

A systematic search was performed across databases including Medline, Embase, and the Cochrane Central Register of Controlled Trials using specific subject headings and keywords in titles/abstracts related to bacterial endocarditis, antibiotics, and prophylaxis. Additionally, reference lists from all selected articles were reviewed. The primary metrics of interest were the occurrence of infective endocarditis, any bacteremia incidence, or, in studies analyzing trends over time, the adjusted incidence rate of infective endocarditis in the population. In cases where the overall bacteremia incidence was not specified, the analysis utilized the time point at which the placebo group exhibited the peak bacteremia incidence for comparison.

Results:

The search yielded 830 articles, which was narrowed down by excluding case reports, editorials, animal research, and duplicates. Upon reviewing titles and/or abstracts, 27 articles qualified for full-text evaluation, with 16 studies ultimately included in the review. All studies used the incidence of bacteremia as an indirect measure for infective endocarditis. The review highlighted 10 studies examining the impact of modifications in national and international guidelines on antibiotic prophylaxis (AP) and its effect on infective endocarditis incidence rates. This comprised nine studies from the USA and Europe focusing on relative AP restrictions and one UK study on the impact of a complete AP restriction.

Conclusions:

The effectiveness and adequacy of the currently recommended antibiotic prophylaxis regimen for preventing infective endocarditis, especially in patients with periodontitis, warrant further discussion. The demographic at higher risk has shifted from younger individuals with known rheumatic heart valve disease to older adults without evident valve pathology. Therefore, a comprehensive systematic review is necessary to collate and evaluate all evidence related to this issue and to determine if the present limitations on AP use are justified.