Awareness of need and actual use of prophylaxis: lack of patient compliance in the prevention of bacterial endocarditis.

Antibiotics are given before some medical and dental procedures to patients with congenital or acquired heart disease to prevent endocarditis. The majority of practitioners and patients are aware of the need for this prophylaxis, although in practice prophylaxis is administered infrequently. It is not known how often patients at risk for endocarditis undergo procedures which warrant the prophylactic administration of antibiotics, nor how often prophylaxis is actually administered to these patients. Two groups of adult patients and a group of children with a cardiac lesion predisposing to endocarditis were surveyed by either telephone interview or mailed questionnaire about awareness of the need for prophylaxis, procedures undergone within six months of the survey and the actual use of prophylaxis before these procedures. Of 455 patients surveyed, 371 (81.5%) responded, 258 (69.5%) of whom remembered receiving advice on prophylaxis. Recollection of advice ranged from 77% of those younger than sixty years to 48% of those aged sixty or older. The patients underwent 68 procedures for which prophylaxis was definitely indicated and 71 procedures with a possible indication for prophylaxis; 127 (91%) of these procedures were dental. Antibiotics were allegedly administered before the procedure to 31 patients (22%). There is marked discrepancy between recollection of the advice and actual use of prophylaxis. In view of this it is likely that patients often undergo procedures without antibiotic protection; however, only a few of these patients develop endocarditis.