[Prevention of bacterial endocarditis. Recommendations of the Swiss Work Group for the Prevention of Endocarditis].

Recommendations of the Swiss Working Group for Prophylaxis of bacterial endocarditis. Despite the lack of definitive evidence for the efficacy of antibiotics in the prevention of bacterial endocarditis (BE) in man, it is accepted practice for antibiotics to be administered to patients at risk of developing BE following a diagnostic or therapeutic procedure which may cause bacteremia. The prophylactic regimens so far recommended are cumbersome and compliance is poor. An attempt is made to unify and simplify Swiss recommendations, taking into account the authors' own recent experimental results, pharmacological data, and clinical experience. It is proposed that the patients be classified into two risk groups: First, patients with congenital and acquired heart disease, previous palliative or non-definitive cardiac surgery, mitral valve prolapse with mitral insufficiency, and hypertrophic obstructive cardiomyopathy should be considered at moderate risk. For those patients a single dose of an orally administered antibiotic should be given 1 h before the procedure. The first choice antibiotic should be amoxicillin (3 g orally) for all procedures, except when S. aureus is likely to cause bacteremia (i.e. after drainage of abscesses, where flucloxacillin (2 g orally) should be used 1 h before the procedure). Amoxicillin is also recommended for patients receiving penicillin during the days prior to the procedure (for prevention of rheumatic fever, or for any other reason). Patients allergic to penicillin should be given 600 mg clindamycin orally 1 h before the procedure. Second, patients with valvular prosthesis or previous BE should be considered at high risk.(ABSTRACT TRUNCATED AT 250 WORDS)