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Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A prospective randomized study was carried out to assess two protocols of antibiotic prophylaxis in patients undergoing cardiac surgery with cardiopulmonary by-pass. Each patient of the first group received four intravenous injections of 1 g cefazolin over a period of 12 h, whilst in the second group each one received twelve doses over a period of 36 h. Between May 1983 and April 1984, 159 patients scheduled for cardiac surgery entered the study. Those who underwent emergency surgery, or weighed less than 20 kg, or received antibiotics in the week before surgery, or had a previous history of anaphylaxis to cephalosporins were not included in the study. Both groups were similar in their distribution of age, weight, height, sex, past history of infectious disease, surgery and iatrogenic factors. There were no significant differences between the two groups in the number of minor infections and bacterial floral changes. There were no major infections either (septicaemia, mediastinitis, endocarditis). Temperature charts were the same on the first four days. The length of stay at hospital was the same in both groups. Since the efficacy of the two protocols in preventing major infections was the same, the authors recommend the short prophylaxis with cephazolin for cardiac surgery patients.
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PMID:[Antibiotic prophylaxis in cardiac surgery: 12-hour cefazolin versus 36-hour cefazolin]. 359 20

Prevention of infective endocarditis continues to concern health care providers in many specialties. The well-known lack of primary clinical trials in this area is not expected to change. Therefore, the evolution of recommendations and practice must be based on theoretic considerations and continuing assessment of secondary sources of information. Recent developments include a report of 52 cases in which antibiotic prophylaxis for infective endocarditis was attempted but appeared to fail. Most of these patients had undergone dental procedures after oral penicillin prophylaxis, with subsequent development of streptococcal endocarditis. In two thirds, the organism was sensitive to the antibiotic used. Notably, the most common underlying cardiac lesion among these patients was mitral valve prolapse. However, two recent independent analyses have concluded that providing endocarditis prophylaxis for all patients with mitral valve prolapse during procedures that might cause bacteremia would not be cost-effective. This is primarily because mitral valve prolapse is common and endocarditis is relatively rare, resulting in an adverse risk-benefit ratio. Parenteral prophylaxis for mitral valve prolapse might even cause a net loss of life from anaphylaxis. On the other hand, for the individual patient or physician, the reassurance provided by attempted prophylaxis with oral penicillin can be purchased at low cost and low risk. Very few cases of infective endocarditis have been reported after gastrointestinal and other endoscopic procedures; most of these do not need antibiotic coverage. Prophylactic antibiotics should be restricted to those situations in which both the procedure and the underlying cardiac condition seem to pose significant risk, for example, endoscopic sclerotherapy of esophageal varices in patients with prosthetic heart valves. Newly revised recommendations have been issued by the Medical Letter, the American Heart Association, and the American Dental Association. These regimens are shorter and simpler than earlier versions.
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PMID:Current issues in prevention of infective endocarditis. 401 77

To assess the cost-effectiveness of prevention of infective endocarditis (IE) and to calculate cost-effectiveness of currently recommended regimens in patients with mitral valve prolapse (MVP), data on risk of death, complications, and health-care use, and cumulative incremental health-care costs due to the occurrence of IE were combined with data on the prevalence and manifestations of MVP, estimated years of life lost, and efficacy of antibiotic prophylaxis. Effectiveness and costs of standard endocarditis prophylaxis regimens were calculated per IE case prevented and years of life saved. Under the most likely scenario, oral amoxicillin prophylaxis for all MVP patients would prevent 32 cases of IE per million dental procedures at approximate costs of $119,000 per prevented case and $21,000 per year of life saved. Limiting prophylaxis to patients with mitral murmurs would prevent 80 cases of IE per million procedures at costs of about $19,000 per prevented case and $3,000 per year of life saved. Erythromycin prophylaxis was slightly less expensive than amoxicillin per benefit because of lower cost and lack of drug anaphylaxis, whereas intravenous ampicillin was 7 to 30 times more costly. Sensitivity analyses suggested that erythromycin prophylaxis might be cost-saving under some scenarios, whereas intravenous ampicillin use might cause net loss of life. Thus, prevention with oral antibiotics of the cumulative morbidity and incremental health care costs due to IE in MVP patients is reasonably cost-effective for MVP patients with mitral murmurs.
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PMID:Cost-effectiveness of infective endocarditis prophylaxis for mitral valve prolapse with or without a mitral regurgitant murmur. 797 41

We review the medical issues and emergencies potentially encountered in the practice of general or surgical dermatology. Traditional guidelines have largely consisted of dated extrapolations from the nondermatologic literature concerning procedures that are primarily irrelevant to dermatology. This article outlines a rational approach to organizing an office emergency plan for anaphylaxis, stroke, status epilepticus, myocardial infarction, and hypertensive crisis. We discuss the literature that has influenced current office behavior regarding endocarditis prophylaxis, the use of electrosurgery with pacemakers, arrhythmogenic drug interactions, vasovagal syncope, lidocaine "allergy," and bleeding complications from oral anticoagulants. Recommendations for managing these issues in a dermatologic context are provided.
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PMID:Medical issues and emergencies in the dermatology office. 948 99

This paper reviews the literature and discusses patient selection for endosseous dental implants and the effect of systemic and local pathology on the success rate of dental implants. Endosseous dental implants may be preferable to conventional dentures in patients with compromised supporting bone or mucosa, xerostomia, allergy to denture materials, severe gag reflex, susceptibility to candidiasis, diseases affecting orofacial motor function or in patients who demand optimal bite force, esthetics, and phonetics. Conventional dentures or fixed partial prostheses may be preferable to endosseous dental implants in growing and epileptic patients and patients at risk of oral carcinoma, anaphylaxis, severe hemorrhage, steroid crisis, endocarditis, osteoradionecrosis, myocardial infarction, or peri-implantitis. A systematic approach to dental implant patient selection is outlined and centralized reporting of dental implant outcomes is recommended.
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PMID:Patient selection for endosseous dental implants: oral and systemic considerations. 1195 1

The intravenous administration to mice of soluble antigen-antibody complexes in antigen excess resulted in a high incidence of glomerulonephritis and less frequently in endocarditis or arteritis. These lesions are present within 48 hours of the first of 3 injections and disappear within 2 weeks. The same pathological changes were produced with complexes prepared from either rabbit or chicken antibody. In the case of rabbit antibody, the severity of the glomerulonephritis was greater with the ovalbumin antiovalbumin system than with the BSA system. Anaphylaxis regularly occurred in mice given complexes prepared from rabbit antibody, but was not seen following administration of complexes prepared from chicken antibody. Pretreatment with cortisone diminished the severity of the glomerulo-nephritis and resulted in accumulation of amorphous, eosinophilic material within glomerular capillaries in mice injected with antigen-antibody complexes. The rabbit antibody used in these experiments failed to sensitize guinea pig skin to passive cutaneous anaphylaxis when injected in the form of soluble complexes. This indicates that these complexes do not dissociate to a detectable extent in vivo and thus favors the interpretation that complexes localize as such in the sites where tissue damage occurs. Chicken anti-mouse erythrocyte antibody produced hemolysis of mouse red cells in the presence of mouse complement. In contrast to a similar rabbit anti-serum, the hemolytic activity of the chicken antibody with mouse complement was very slight. This suggests that complement does not play an important role in the pathogenesis of these experimental lesions.
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PMID:The pathologic effects of intravenously administered soluble antigen-antibody complexes. I. Passive serum sickness in mice. 1377 4

Bacterial endocarditis (BE), a rare heart infection caused by a bacteremia, has frequently been blamed on but rarely caused by dental procedures. Viridans group streptococci are found abundantly in the mouth and the gingival sulcus but have been surpassed by staphylococci as the leading cause of BE. Antibiotic prophylaxis has been recommended before dental procedures in patients at risk for BE, but it remains controversial because studies have failed to show that antibiotic prophylaxis is an effective preventive for BE or that dental procedures are an important cause of BE. The risks and costs of antibiotic prophylaxis, including antibiotic resistance, cross-reactions with other drugs, allergy, anaphylaxis, and even death, may exceed the benefits in preventing BE. The rationale for the use of antibiotic prophylaxis to prevent BE allegedly caused by dental procedure bacteremias must be seriously reexamined based on recent evidence, particularly the absolute risk rates for endocarditis after a given dental procedure.
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PMID:Dentistry and Endocarditis. 1596 25

During the last five years there has been a considerable change in attitude towards antibiotic prophylaxis of endocarditis in many countries so that far fewer cardiac patients are advised to receive prophylaxis in comparison with previous years. Much greater emphasis is now given to the maintenance of good oral hygiene as the main method of preventing endocarditis and prophylaxis is only recommended for patients with the highest risk cardiac conditions undergoing dental procedures. Most countries have now abandoned prophylaxis for urological and gastrointestinal procedures. The UK National Institute for Health and Clinical Excellence guidance, which does not recommend prophylaxis for any group of patients undergoing dental procedures, is regarded as too extreme by many experts in other countries. The assertion that more patients would die from fatal anaphylaxis after oral amoxicillin, the main prophylactic agent, than would die from endocarditis because prophylaxis is withheld, may not be correct since the risks of dying after oral amoxicillin have probably been overestimated. There is a lack of clinical evidence either for or against the efficacy of antibiotic prophylaxis. Unless convincing data is obtained from future research any new international consensus guidelines will continue to be based mainly on expert opinion rather than on good evidence.
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PMID:New guidelines and the development of an international consensus on recommendations for the antibiotic prophylaxis of infective endocarditis. 2403 64

Links between infective endocarditis (IE) and dental and other invasive procedures were first identified in the 1920s, and the use of antibiotic prophylaxis (AP) to prevent IE was first recommended by the American Heart Association in 1955. Recognising the weak evidence to support this practice and the wider risks of anaphylaxis and antibiotic resistance, guidelines in the USA and Europe have been rationalised in the last decade with restriction of AP to those patients perceived to be at the highest risk. In the UK, the National Institute for Health and Care Excellence controversially recommended the complete cessation of AP for all invasive procedures in 2008 and subsequent epidemiological studies have suggested a significant increase in cases above the baseline trend. AP appears to be safe and is likely to be cost-effective. Until further data are available, we recommend continued adherence to US and European guidelines.
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PMID:Antibiotic Prophylaxis of Infective Endocarditis. 2823 91