Clinical inquiries. When should patients with mitral valve prolapse get endocarditis prophylaxis?

■ EVIDENCE-BASED ANSWER Patients with suspected mitral valve prolapse (MVP) (Figure 1) should undergo echocardiography before any procedure that may place them at risk for bacteremia. Patients with MVP and documented absence of mitral regurgitation or valvular thickening likely do not need antibiotic prophylaxis against subacute bacterial endocarditis (SBE). Patients with MVP with documented mitral regurgitation, valvular thickening, or an unknown degree of valvular dysfunction may benefit from antibiotics during procedures that often lead to bacteremia (strength of recommendation: C).