The British guidelines (NICE) carried the revisions furthest, with recommendations to eliminate prophylactic antibiotic drugs altogether for all patients under any circumstances. In sum- mary, the AHA and the European Society of Cardiology state- ments limit the use of prophylactic antibiotic drugs to patients in whom the risk for IE is highest (eg, patients with a history of previous IE), and equally important but somewhat more controversial, recommend antibiotic drugs be considered for those patients with the greatest risk for morbidity or mortality from IE (eg, heart transplant patients with a valvulopathy in the implanted heart). Since the publications of these recommendations, at least 1 study has documented the lack of any demonstrable increase in IE as a cause of hospitalization for children,72 and another has carefully documented the absence of any impact on the rate of IE case development in the United Kingdom, where the NICE guidelines have been in place and where antibiotic dispensing for IE prophylaxis is moni- Children who are at risk for IE and their families and care providers can benefit from education about the impor- tance of good oral health and the techniques useful for its maintenance. Additionally, children with cyanosis may have specific periodontal concerns, which makes optimum oral hygiene particularly important for them.3 The AHA recom- mends that for those in the highest-risk groups, there may still be a role for prophylactic antibiotic drugs. Families of children and young adults, in particular, are counseled that their risk for IE might actually increase as they become subject to cardiovascular therapies for their CHD, although those conditions might not have required IE prophylaxis before treatment. In this regard, valve replacement and septal defect occlusion with prosthetic devices are relevant exam- ples. In the last review of IE prophylaxis, the conditions the Table 10. 