Antibiotic Prophylaxis for Bacterial Endocarditis: An Evolving Story With New Paradigms-Reply

We read with great interest the critical comments of the 3 distinguished members of the AHA Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease. Our intention, of course, was not to challenge the committee's recommendations, which are based on long, extensive research and vast clinical experience. We merely wanted to report our experience and thoughts about the subject. Without pathologic evidence, the diagnosis of endocarditis is never definite. Yet, endocarditis was confirmed, in the cases presented, both by blood cultures that were positive for microorganisms typical of infective endocarditis and by vegetations that were seen on echocardiograms by an expert. However, based on our clinical experience and the current liberalized Duke criteria, the 6 cases we reported were indeed endocarditis. We cannot prove the link with the gastrointestinal procedures, but the time sequence in all but 1 of the cases is very suggestive. Bacterial resistance is a serious issue emerging