The prophylaxis and treatment of bacterial infective endocarditis in adults

Infective endocarditis is a relatively rare disease that has an associated high morbidity and mortality. The basic pathology involves the adherence of micro-organisms to areas of endothelial damage, causing local infection resulting in the formation of vegetations. Complications include sepsis, valvular failure and embolization. The diagnosis is based on the Duke criteria but can be difficult to establish, particularly when blood cultures are negative or transthoracic echocardiography images are non-diagnostic. There has recently been a change in guidance regarding which patients should be given antibiotics to prevent endocarditis whilst undergoing various procedures. Antibiotics are the mainstay of treatment but surgical debridement and valvular surgery is sometimes required. This review article details the rationale for the recent changes in antibiotic prophylaxis guidance and outlines current antibiotic treatment regimens for infective endocarditis.