van der Meer J T M
Department of Internal Medicine F4-217, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Neth J Med. 2002 Dec;60(11):423-7.
For a long time it has been known that bacteraemias caused by medical or dental procedures may cause endocarditis in patients with specific types of congenital or acquired heart disease. In the 1940s it was thought that the administration of antibiotics before such procedures would prevent endocarditis. However, the beneficial effect of this preventive measure on the incidence of endocarditis did not live up to its expectations. Quite soon it became obvious that prophylaxis was not 100% efficacious in man, although it did prevent endocarditis in animals. A controlled study into the protective effect of prophylaxis in humans has never been carried out. In the last decade it has become dear from case-control studies that endocarditis prophylaxis is not a very effective preventive measure but that it reduces an already small risk even further. In this article the theoretical background of endocarditis prophylaxis and possible explanations for its lack of effect are discussed.
长期以来，人们一直知道，医疗或牙科手术引起的菌血症可能会导致特定类型先天性或后天性心脏病患者发生心内膜炎。在20世纪40年代，人们认为在这类手术前使用抗生素可以预防心内膜炎。然而，这种预防措施对心内膜炎发病率的有益效果并未达到预期。很快就明显看出，尽管预防措施在动物身上确实能预防心内膜炎，但在人类中并非100%有效。从未对人类进行过关于预防措施保护效果的对照研究。在过去十年中，病例对照研究表明，心内膜炎预防并非非常有效的预防措施，但它能进一步降低原本就很小的风险。本文讨论了心内膜炎预防的理论背景及其缺乏效果的可能原因。
