Prevention of bacterial endocarditis: 1991

Article Abstract:

Endocarditis is an infection of a structurally abnormal heart valve by bacteria, generally requiring weeks of intravenous antibiotic therapy and not infrequently open heart surgery to repair or replace the damaged valves. People with certain recognized structural abnormalities of their valves risk endocarditis whenever they undergo certain medical and dental procedures that run a high risk of introducing bacteria to the bloodstream. These procedures include most dental procedures and manipulations of the urinary tract or colon. Recommendations are issued periodically on the use of prophylactic (preventive) antibiotics before and after these procedures, in an attempt to decrease the incidence of endocarditis in those at risk. The most recent recommendations, issued in December, 1990, include the use of amoxicillin or erythromycin for dental work, and either ampicillin or vancomycin intravenously for procedures involving the urinary tract or bowel. Prophylaxis for patients with mitral valve prolapse, a relatively common heart abnormality, has been controversial. Mitral valve prolapse accompanied by certain clinical features which clearly mark it as significant warrants antibiotic prophylaxis, but the less serious manifestations of it do not. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Risk factors, Mitral valve prolapse, editorial, Endocarditis

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Treatment of infective endocarditis

Article Abstract:

The American Heart Association has proposed new guidelines for the treatment of patients with endocarditis. Single daily home injections of ceftriaxone for four weeks may be appropriate for patients with uncomplicated endocarditis caused by Streptococcus or other organisms including Actinobacillus, Haemophilus, Eikenella, Kingella, or Cardiobacterium. Studies have shown this treatment to be 98% effective in selected patients with streptococcal infections. Doctors should test patients for resistance to penicillin and aminoglycosides before treatment due to the increasing numbers of patients with endocarditis found to be resistant to these drugs. Ampicillin, penicillin G, or vancomycin treatment may be appropriate for patients resistant to both streptomycin and gentamicin. However, this therapy is typically only 50% effective and patients are likely to require heart surgery if the therapy is ineffective. A short two-week treatment with nafcillin, cloxacillin, and an aminoglycoside may be appropriate for selected patients with endocarditis limited to the tricuspid valve.

Editorial, Drug therapy

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Dental and Cardiac Risk Factors for Infective Endocarditis

Article Abstract:

It may not be necessary to give people with heart valve abnormalities antibiotics before dental treatment. This is often done to prevent endocarditis, a bacterial infection inside the heart. Researchers analyzed the rate of dental treatment among people with endocarditis in 54 Philadelphia hospitals and healthy people from the community. Patients with endocarditis were no more likely to have had dental treatment in the previous three months than healthy people. This was true even in endocarditis patients with known heart valve abnormalities.

Dental care, Oral hygiene

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