Clinician compliance and the prevention of bacterial endocarditis.

Analysis of our data indicates confusion about, and lack of compliance with, the AHA recommendations. Clinician level of knowledge varies with issues of risk management and by specialty group membership. Patient groups that are particularly problematic include children and all patients with congenital heart disease, those receiving a continuing antibiotic regimen for secondary prevention of rheumatic fever, those with a penicillin allergy, and those with prosthetic heart valves. Another area of clinician uncertainty concerns dental procedures which may or may not be associated with the possible causation of bacterial endocarditis. The biodynamic principles involved in endocarditis are central to the structure of the AHA recommendations. These principles, as well as those which provide theoretical support for the loading dose, timing, sequence, and duration recommended by the AHA, have been presented with the hope that clinician compliance with these recommendations will be increased.