Endocarditis prophylaxis: an evolution of change.

摘要

In 1955, the American Heart Association (AHA) started making recommendations for the prevention of infective endocarditis. Since then, patients considered at increased risk of infective endocarditis who were undergoing certain dental procedures or upper respiratory, gastrointestinal (GI), or genitourinary (GU) tract procedures were prescribed antibiotics,, The first guidelines recommended a regimen of penicillin administered intramuscularly 30 minutes before an operative procedure. The most recent guidelines, summarized in this issue of American Family Physician, are the ninth revision of the original recommendations and represent a significant change because the AHA no longer recommends endocarditis prophylaxis for most patients. Although some of the recommendations are radical departures from previous versions, they are in other ways a step in the evolution of the guidelines that began more than 50 years ago. Through the years, subsequent revisions have changed the dosing to cover a five-day period, a two-day period, two doses on the same day, and, finally, a single dose, It was not until the mid-1980s that an option for an all-oral dosing regimen was given.