Which condition requires antibiotic prophylaxis for endocarditis?

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Prophylaxis is reserved for patients at highest risk of infective endocarditis, especially when a foreign or abnormal surface in the heart can readily harbor bacteria that reach the bloodstream during procedures. A prosthetic heart valve provides artificial material that can serve as a nidus for bacterial growth if bacteremia occurs, so giving antibiotics beforehand reduces the chance of endocarditis after procedures that can introduce bacteria.

Hypertension and atrial fibrillation aren’t associated with an increased risk of endocarditis requiring routine antibiotic prophylaxis. Mitral valve prolapse used to be a consideration, but current guidelines do not routinely require prophylaxis for MVP unless other high-risk features are present.