Brubakk O, Bruun J N, Hovig B, Andrew M, Eskerud J, Skoglund L A
Sentralsykehuset for Ostfold, Avdeling Sarpsborg.
Tidsskr Nor Laegeforen. 1992 Feb 10;112(4):466-71.
Bacterial endocarditis is a serious condition with high lethality. The authors review the etiology of the disease and conditions and procedures associated with increased risk, and give recommendations on choice and dosage of effective antibiotics. Most cases of endocarditis are caused by gram-positive cocci of the genera Streptococcus, Enterococcus or Staphylococcus. The number of cases caused by staphylococci has increased in recent decades. Risk of acquiring endocarditis is higher, for example, in patients with prosthetic cardiac valves and in patients with a previous history of endocarditis. Interventions associated with increased risk include various procedures in the mouth, throat and upper airways, since this is where the bacteria most often causing endocarditis are to be found. A single oral dose of amoxycillin is recommended for standard prophylaxis, and ampicillin in combination with an aminoglycoside for parenteral use. In cases of penicillin allergy, a single oral dose of clindamycin is recommended in patients at risk of bacteriemia from the respiratory tract, with trimetoprim as an alternative for genito-urinary and gastrointestinal procedures. Vancomycin or vancomycin plus aminoglycoside is recommended as a parenteral regimen in cases of penicillin allergy.
细菌性心内膜炎是一种致死率很高的严重疾病。作者回顾了该疾病的病因以及与风险增加相关的情况和操作，并就有效抗生素的选择和剂量给出了建议。大多数心内膜炎病例由链球菌属、肠球菌属或葡萄球菌属的革兰氏阳性球菌引起。近几十年来，葡萄球菌引起的病例数有所增加。例如，人工心脏瓣膜患者和有过心内膜炎病史的患者患心内膜炎的风险更高。与风险增加相关的干预措施包括口腔、咽喉和上呼吸道的各种操作，因为这是最常发现引起心内膜炎的细菌的部位。标准预防推荐单次口服阿莫西林，胃肠外用药推荐氨苄西林联合一种氨基糖苷类药物。对于青霉素过敏的患者，呼吸道有菌血症风险的患者推荐单次口服克林霉素，泌尿生殖系统和胃肠道操作时可用甲氧苄啶作为替代。青霉素过敏时，胃肠外用药方案推荐万古霉素或万古霉素加氨基糖苷类药物。
