Infective endocarditis (IE) is a potentially catastrophic disease that was uniformly fatal in the preantibiotic era, and it still carries an unacceptably high rate of morbidity and mortality. Such a sinister disease warrants attempts at prevention. However, prevention of IE with antibiotics is neither reasonable nor possible in the foreseeable future and results in considerable harm.
Several preconditions are necessary for antibiotic prophylaxis (AP) to be the right approach to IE prevention: First, inciting events must be identified as a target of prophylaxis. Second, a subset of the population at increased risk of developing IE and undergoing the inciting event must be identified. Third, a simple, efficacious, and effective method of AP must be identified. Finally, the resultant net health of the population receiving AP must be better than if they had not received it.