How does antibiotic prophylaxis prevent infective endocarditis (IE)?

Updated: Jan 03, 2019
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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The AHA periodically compiles recommendations for IE prophylaxis (Go to updated guidelines, October 2007). [99] It is important to remember that these are not standards but guidelines and thus may be modified in particular circumstances. The guidelines remain unproven by randomized controlled clinical trials. Indeed, many examples of failure of these recommendations have been noted, even when they are applied appropriately. [100]

The 3 major steps in the pathogenesis of IE that are vulnerable to antibiotic prophylaxis are the following:

  1. Killing of the pathogen in the bloodstream before it can adhere to the valve
  2. Preventing adherence to the valve/fibrin-platelet thrombus
  3. Eradicating any organisms that have attached to the thrombus

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