RT Journal Article SR Electronic T1 Antibiotic prophylaxis for infective endocarditis: a systematic review and meta-analysis JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP 937 OP 944 DO 10.1136/heartjnl-2015-309102 VO 103 IS 12 A1 Thomas J Cahill A1 James L Harrison A1 Paul Jewell A1 Igho Onakpoya A1 John B Chambers A1 Mark Dayer A1 Peter Lockhart A1 Nia Roberts A1 David Shanson A1 Martin Thornhill A1 Carl J Heneghan A1 Bernard D Prendergast YR 2017 UL http://heart.bmj.com/content/103/12/937.abstract AB Objective The use of antibiotic prophylaxis (AP) for prevention of infective endocarditis (IE) is controversial. In recent years, guidelines to cardiologists and dentists have advised restriction of AP to high-risk groups (in Europe and the USA) or against its use at all (in the UK). The objective of this systematic review was to appraise the evidence for use of AP for prevention of bacteraemia or IE in patients undergoing dental procedures.Methods We conducted electronic searches in Medline, Embase, Cochrane Library and ISI Web of Science. We assessed the methodological characteristics of included studies using the Strengthening the Reporting of Observational Studies in Epidemiology criteria for observational studies and the Cochrane Risk of Bias Tool for trials. Two reviewers independently determined the eligibility of studies, assessed the methodology of included studies and extracted the data.Results We identified 178 eligible studies, of which 36 were included in the review. This included 10 time-trend studies, 5 observational studies and 21 trials. All trials identified used bacteraemia as an endpoint rather than IE. One time-trend study suggests that total AP restriction may be associated with a rising incidence of IE, while data on the consequences of relative AP restriction are conflicting. Meta-analysis of trials indicates that AP is effective in reducing the incidence of bacteraemia (risk ratio 0.53, 95% CI 0.49 to 0.57, p<0.01), but case–control studies suggest this may not translate to a statistically significant protective effect against IE in patients at low risk of disease.Conclusions The evidence base for the use of AP is limited, heterogeneous and the methodological quality of many studies is poor. Postprocedural bacteraemia is not a good surrogate endpoint for IE. Given the logistical challenges of a randomised trial, high-quality case–control studies would help to evaluate the role of dental procedures in causing IE and the efficacy of AP in its prevention.