Antibiotic prophylaxis for infective endocarditis: some rarely addressed issues

Although quite consistent indications on antibiotic prophylaxis for infective endocarditis (IE) have been reported internationally, several common dental practice issues are still not clear: which dental procedures require antibiotic prophylaxis? In the case of multiple procedures can the same antibiotic be used? How can dentists identify high-risk conditions for IE? Do dentists verify patient antibiotic intake? What are the requirements of antibiotic prophylaxis in cases of coexistence of diseases which involve host defence impairment? What are the modalities of second choice drug administration? And finally, are chlorhexidine mouthwashes before dental procedures combined with antibiotics useful or not? Uncertainty also persists as far as the real need for prophylaxis is concerned and although several sources have suggested that a wide prospective randomised controlled study may be the definitive solution, problems exist in performing such a study.