We appreciate the interest and comments of Silva Conde et al. regarding our article.1 In fact, they published an article in 2012 in Revista Española de Cardiología on how closely dentists followed the recommendations on infectious endocarditis (IE) prophylaxis.2 Their results were similar to those of our study, carried out 6 years later.1 Indeed, we cited their study in a previous article in which we compared IE prophylaxis approaches in different healthcare professionals (dentists, primary care physicians, and cardiologists) in Cordoba.3

Prophylaxis should be avoided in patients with no indication (those with atrial fibrillation, stents, or coronary artery bypass grafting). However, in other situations such as native valve disease or mitral prolapse, we believe that caution should be exercised, as several very recent studies4,5 indicate a high risk of IE in these conditions. In one Spanish study,5 the incidence of Streptococcus viridans IE was higher in patients with a bicuspid aortic valve and mitral prolapse than in those with conditions considered moderate or high risk. Another study also reported a high incidence of IE after invasive procedures (transfusions, coronary surgery, bronchoscopy, dialysis),4 which contradicts current recommendations.

In conclusion, we should avoid misuse of antibiotics in situations that are clearly no-risk, but exercise caution in light of the new evidence that the risk of IE in moderate-risk cardiac disease (essentially valve disease and congenital heart disease) may be higher than previously thought.