Prevention of Bacterial Endocarditis

摘要: Objective. —To update recommendations issued by the American Heart Association last published in 1990 for prevention of bacterial endocarditis individuals at risk this disease. Particpants. —An ad hoc writing group appointed their expertise and treatment with liaison members representing Dental Association, Infectious Diseases Society America, Academy Pediatrics, Gastrointestinal Endoscopy. Evidence. —The article reflect analyses relevant literature regarding procedure-related endocarditis, vitro susceptibility data pathogens causing results prophylactic studies animal models retrospective human cases terms antibiotic prophylaxis usage patterns apparent failures. MEDLINE database searches from 1936 through 1996 were done using root wordsendocarditis, bacteremia, andantibiotic prophylaxis. Recommendations document fall into evidence level III US Preventive Services Task Force categories evidence. Consensus Process. formulated after specific therapeutic regimens discussed. The consensus statement was subsequently reviewed outside experts not affiliated Science Advisory Coordinating Committee Association. These guidelines are meant to aid practitioners but intended as standard care or a substitute clinical judgment. Conclusions. —Major changes updated include following: (1) emphasis that most attributable an invasive procedure; (2) cardiac conditions stratified high-, moderate-, negligible-risk based on potential outcome if develops; (3) procedures may cause bacteremia which is recommended more clearly specified; (4) algorithm developed define when patients mitral valve prolapse; (5) oral dental initial amoxicillin dose reduced 2 g, follow-up no longer recommended, erythromycin penicillin-allergic individuals, clindamycin other alternatives offered; (6) gastrointestinal genitourinary procedures, have been simplified. instituted improve practitioner patient compliance, reduce cost adverse effects, approach uniform worldwide recommendations.