Endocarditis Prophylaxis
D'Arcy Little, MD, CCFP
Director of Medical Education,
York Community Services,
Toronto, ON.
Introduction
Endocarditis is a relatively uncommon but potentially life-threatening infection.1 The condition was first described by Lazare Rivere in 1646, although William Osler's name has a more current association given that the clinical feature, "Osler's nodes," bears his name.2 Prior to the development of antibiotics, endocarditis was almost universally fatal; despite recent advances in diagnosis and treatment, the condition continues to have a 37% mortality rate.1,3 Endocarditis is also associated with significant morbidity, including the development of valvular dysfunction, congestive heart failure, and focal neurologic or septic complications associated with embolic phenomena.1,3
Due to the considerable morbidity and mortality associated with endocarditis, where possible, primary prevention is the optimal goal. Although the details are controversial, endocarditis prophylaxis with antibiotics is directed towards this goal. However, studies have revealed that compliance with endocarditis prophylaxis guidelines is less than complete.4 The following article will review some of the controversies associated with, and the details of, endocarditis prophylaxis.
