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This report aimed to examine temporal changes in the number of recommendations on management of infective endocarditis in the European and American guidelines. The number of recommendations has increased since 2004 without an increment in evidence base in the European iteration. American guidelines have reduced the number of recommendations with a main evidence base of level B., Competing Interests: Conflict of interest Lauge Østergaard: Independent research grant from the Novo Nordisk Foundation for the research of mitral valve regurgitation. Lars Køber: Speakers honorarium from Novo, Novartis, AstraZeneca, Boehringer and Bayer Emil Loldrup Fosbøl: Novo Nordisk Foundation and the Danish Heart Association: Independent research grant related to valvular heart disease and endocarditis. Sofie Truong, Eva Havers-Borgersen and Jeppe Petersen: None., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)