Flückiger U, Malinverni R, Francioli P
Département de médecine interne, CHUV, Lausanne.
Ther Umsch. 1991 Apr;48(4):225-31.
Infective endocarditis is a serious disease and should be, if possible, prevented. Two risk groups are classified in relation to the patient's underlying cardiac lesions. At high risk are patients with prosthetic valves or with a previous infective endocarditis. Patients with congenital and acquired heart disease, mitral valve prolapse with regurgitation and hypertrophic obstructive cardiomyopathy are at moderate risk. Patients of these two groups should receive antibiotic prophylaxis before dental or surgical procedures that cause bacteremia. For patients at moderate risk a single dose of an orally administered antibiotic should be given one hour before the procedure (e.g. amoxicillin 3 g for procedures of the oropharyngeal, gastrointestinal or genitourinary tract, where the causitive agents of endocarditis are Viridans streptococci or enterococci). Multiple doses are recommended for patients at high risk. The combination of amoxicillin and gentamicin (vancomycin and gentamicin in penicillin-allergic patients) offers the widest margin of safety in high-risk patients.
感染性心内膜炎是一种严重疾病，应尽可能予以预防。根据患者潜在的心脏病变可将其分为两个风险组。人工瓣膜患者或曾患感染性心内膜炎的患者属于高危人群。先天性和后天性心脏病患者、伴有反流的二尖瓣脱垂患者以及肥厚性梗阻性心肌病患者属于中危人群。这两组患者在进行可导致菌血症的牙科或外科手术前均应接受抗生素预防。对于中危患者，应在手术前1小时口服单剂量抗生素（例如，对于口咽、胃肠道或泌尿生殖道手术，若心内膜炎病原体为草绿色链球菌或肠球菌，可服用阿莫西林3克）。高危患者建议使用多剂量抗生素。阿莫西林与庆大霉素联合使用（对青霉素过敏的患者使用万古霉素和庆大霉素）在高危患者中具有最广泛的安全范围。
