Prevention of bacterial endocarditis

Abstract

A major review of the American Heart Association guidelines for endocarditis prophylaxis was published in 1997. In view of changing perspectives on the population at risk for endocarditis and new information on the likelihood of particular procedures to place patients at risk, simplified guidelines have been developed. The role of invasive procedures as a risk factor is deemphasized, simplified single-dose strategies are suggested, and parenteral regimens are required less frequently. In addition, more extensive alternatives to erythromycin, including the newer macrolide antibiotics, are now part of the recommendations for patients who are unable to take penicillins. The new report also discusses the appropriateness of prophylaxis in the presence of the complicated issue of mitral valve prolapse and the relationship of valvar flow patterns to risk for endocarditis. Although no definitive randomized trials have been performed unequivocally establishing the benefits of endocarditis prophylaxis, the new guidelines represent an effort to favorably modify the risk-benefit ratio for use of antibiotics in the patient at risk. In addition to the new guidelines, other recent reports emphasize the importance of associated nonpharmacologic methods to prevent endocarditis, such as meticulous skin care and personal hygiene, and the need for a determined educational approach in the patient at risk to minimize risk. Recent reports have also emphasized the need for pediatric awareness of the changing patient population at risk for endocarditis and the need for increased vigilance in particular patients.