Ospedale Maria Vittoria di Torino, Italy.
J Cardiovasc Med (Hagerstown). 2010 Jun;11(6):419-25. doi: 10.2459/JCM.0b013e328333927c.
Antibiotic prophylaxis of patients believed to be at a risk of developing infective endocarditis has been recently revisited with limited indications compared with the previous body of knowledge in use by the medical community. As a consequence, most of the healthcare specialists in cardiology and infectious diseases have doubts related to the enormous change that has been proposed. In this study, we report the results of an Italian consensus of experts in cardiology and infectious diseases, with the aim to offer a national document that illustrates the reasons for such a change through the review of the basis of infective endocarditis prophylaxis, the historical background, and the reasons for the change, providing practical conclusions and illustrating grey areas.
The main guidelines published on the topic of antibiotic prophylaxis for infective endocarditis were discussed as well as the risk of anaphylaxis. Overall, the group agreed that the evidence for prophylaxis is weak and limited to few case-control studies, expert opinion, clinical experience, and descriptive studies.
The 'downgrading' of the indications for prophylaxis is mainly due to a cultural change and a more critical attitude towards available published data. Although the group acknowledge the critical view of the previously published guidelines, it seems to be more practical to consider the issue of prophylaxis without the evidence required by guidelines but rather as a consensus document based on the available data.
Contemporary guidelines on infective endocarditis prophylaxis challenge previous recommendations based on a low level of evidence. The main recommendation of the study group is to underline that prophylaxis may often be based on adequate education without the administration of antibiotics, which only remains suggested, following the usual practice, in patients with heart diseases, when the risk of a complicated prognosis following infective endocarditis may be anticipated.
与以前医学界使用的知识体系相比，最近对被认为有发生感染性心内膜炎风险的患者进行抗生素预防的建议有所减少。因此，大多数心脏病学和传染病学的医疗专家对提出的巨大变化都存在疑问。在这项研究中，我们报告了意大利心脏病学和传染病学专家的共识结果，旨在通过审查感染性心内膜炎预防的基础、历史背景和变化原因，提供一份国家文件，说明这种变化的原因，并举例说明灰色地带。
讨论了关于感染性心内膜炎抗生素预防的主要指南以及过敏反应的风险。总的来说，专家组认为预防的证据薄弱，仅限于少数病例对照研究、专家意见、临床经验和描述性研究。
预防适应症的“降级”主要是由于文化的改变和对现有发表数据的更批判性态度。尽管专家组承认对以前发布的指南的批评观点，但似乎更实际的做法是考虑预防问题，而无需遵循指南要求的证据，而是将其视为基于现有数据的共识文件。
当代感染性心内膜炎预防指南挑战了以前基于低证据水平的建议。研究小组的主要建议是强调预防措施通常可以基于适当的教育而不使用抗生素，只有在心脏病患者中，当可以预期感染性心内膜炎后预后复杂的风险时，才根据常规做法建议使用抗生素。
