Antibiotic prophylaxis for patients with certain types of heart disease (e.g., rheumatic heart disease, infective endocarditis, and congenital heart disease [CHD]) is part of standard medical therapy in most developed nations. Infective endocarditis (IE) is less common in children than in adults. Although the incidence of rheumatic heart disease in developed countries has decreased, it appears that the incidence of IE in children has been increasing, due to, in part, improved survival of potentially at-risk children, such as those with CHD and those with indwelling venous catheters. In the developed world, CHD is the most common risk factor for IE.

Cardiac endothelial damage is the initiating factor for IE. In children with CHD, shear forces from high-velocity aberrant blood flow can damage the cardiac endothelium. Alternatively, damage may be caused by catheter-induced trauma. A thrombus can form at the site of damage. If a child subsequently has transient bacteremia with an organism capable of causing endocarditis, the thrombus may become infected. The most common etiologic organisms for IE in children are streptococci and staphylococci, especially viridans group streptococci and Staphylococcus aureus. Bacterial proliferation results in the formation of vegetations. The goal of antibiotic prophylaxis is to prevent or quickly treat bacteremia and prevent IE in susceptible patients. Despite its widespread practice, no study has ever demonstrated that antimicrobial prophylaxis in at-risk individuals prior to invasive procedures definitively prevents IE.

Because the presentation of IE is generally insidious with fever and other nonspecific systemic complaints (e.g., weakness, fatigue and weight loss) physicians must have a high degree of suspicion in the appropriate clinical circumstance. Once suspected, the Duke criteria, comprised of major and minor criteria, can be used to assist in diagnosing IE in children. The major Duke criteria are as follows: