Infective endocarditis

(Canada--Canadian Family Physician, November 2000, p. 2248.) Bacterial endocarditis usually involves damaged heart valves, but can occur on any area of damaged endothelium. The infection is typically caused by transient bacteremia from infection in other areas of the body, such as pneumonia, or from instruments used during dental or other surgery. Established bacterial endocarditis has a mortality rate of approximately 37 percent and can lead to significant morbidity among survivors. Patients at high risk of bacterial endocarditis include those with prosthetic heart valves, congenital heart disease and previous history of bacterial endocarditis. Patients with cardiomyopathy and acquired valvular disease are generally at moderate risk. Patients with pacemakers, history of coronary artery bypass surgery, functional heart murmurs and acquired valvular disease without dysfunction are typically at negligible risk (no greater than the general population). In such patients, prophylaxis is not recommended. Prophylaxis is recommended in patients with mitral valve prolapse when a murmur is present and/or echocardiography shows mitral regurgitation. Amoxicillin in a dose of 2 g administered one hour before the procedure is currently recommended. Clindamycin in a dose of 600 mg is recommended for patients who are allergic to penicillin. Current recommendations do not include a second dose of antibiotic following the procedure.

COPYRIGHT 2001 American Academy of Family Physicians
COPYRIGHT 2001 Gale Group