Dajani A S, Taubert K A, Wilson W, Bolger A F, Bayer A, Ferrieri P, Gewitz M H, Shulman S T, Nouri S, Newburger J W, Hutto C, Pallasch T J, Gage T W, Levison M E, Peter G, Zuccaro G
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To update recommendations issued by the American Heart Association last published in 1990 for the prevention of bacterial endocarditis in individuals at risk for this disease.
An ad hoc writing group appointed by the American Heart Association for their expertise in endocarditis and treatment with liaison members representing the American Dental Association, the infectious Diseases Society of America, the American Academy of Pediatrics and the American Society for Gastrointestinal Endoscopy.
The recommendations in this article reflect analyses of relevant literature regarding procedure-related endocarditis, in vitro susceptibility data of pathogens causing endocarditis, results of prophylactic studies in animal models of endocarditis and retrospective analyses of human endocarditis cases in terms of antibiotic prophylaxis usage patterns and apparent prophylaxis failures. MEDLINE database searches from 1936 through 1996 were done using root words endocarditis, bacteremia and antibiotic prophylaxis. Recommendations in this document fall into evidence level III of the U.S. Preventive Services Task Force categories of evidence.
The recommendations were formulated by the writing group after specific therapeutic regimens were discussed. The consensus statement was subsequently reviewed by outside experts not affiliated with the writing group and by the Science Advisory and Coordinating Committee of the American Heart Association. These guidelines are meant to aid practitioners but are not intended as the standard of care or as a substitute for clinical judgment.
Major changes in the updated recommendations include the following: (1) emphasis that most cases of endocarditis are not attributable to an invasive procedure; (2) cardiac conditions are stratified into high-, moderate- and negligible-risk categories based on potential outcome if endocarditis develops; (3) procedures that may cause bacteremia and for which prophylaxis is recommended are more clearly specified; (4) an algorithm was developed to more clearly define when prophylaxis is recommended for patients with mitral valve prolapse; (5) for oral or dental procedures the initial amoxicillin dose is reduced to 2 g, a follow-up antibiotic dose is no longer recommended, erythromycin is no longer recommended for penicillin-allergic individuals, but clindamycin and other alternatives are offered.
更新美国心脏协会上次于1990年发布的关于预防细菌性心内膜炎高危个体患此病的建议。
由美国心脏协会任命的一个特设写作小组，其成员在治疗心内膜炎方面具有专业知识，并设有代表美国牙科协会、美国传染病学会、美国儿科学会和美国胃肠内镜学会的联络成员。
本文中的建议反映了对有关与手术相关的心内膜炎的相关文献、引起心内膜炎的病原体的体外药敏数据、心内膜炎动物模型中的预防性研究结果以及根据抗生素预防使用模式和明显的预防失败情况对人类心内膜炎病例进行的回顾性分析。使用关键词心内膜炎、菌血症和抗生素预防对1936年至1996年的MEDLINE数据库进行了检索。本文件中的建议属于美国预防服务工作组证据类别的III级证据。
写作小组在讨论了具体治疗方案后制定了这些建议。随后，该共识声明由与写作小组无关的外部专家以及美国心脏协会科学咨询与协调委员会进行了审查。这些指南旨在帮助从业者，但并非作为护理标准或临床判断的替代品。
更新建议中的主要变化如下：（1）强调大多数心内膜炎病例并非由侵入性手术引起；（2）根据心内膜炎发生时的潜在后果，将心脏状况分为高风险、中风险和可忽略风险类别；（3）更明确地规定了可能导致菌血症且建议进行预防的手术；（4）制定了一种算法，以更明确地界定何时建议对二尖瓣脱垂患者进行预防；（5）对于口腔或牙科手术，阿莫西林初始剂量减至2 g，不再建议使用后续抗生素剂量，对于青霉素过敏个体不再建议使用红霉素，但提供了克林霉素和其他替代药物。
