Prevention of infective endocarditis associated with dental treatment and other medical interventions. National Heart Foundation.

The prevention of infective endocarditis is extremely important for people with valvular heart disease and other high-risk cardiac conditions. The following is the National Heart Foundation's updated recommendations for the prophylaxis of infective endocarditis. The recommended antibiotic regimens have changed considerably from the previous guidelines. In response to these guidelines, Pharmac has instituted a number of changes to the Schedule to reduce the barriers to prescribing the recommended drugs for this indication. Pharmac expects that the last of these drugs to be listed on the Schedule (cefuroxime axetil) will be in place by 1 October 1999. Prescriptions will need to be endorsed "prophylaxis for endocarditis". Therefore, any prescriber (doctor or dentist) will be able to prescribe the recommended drugs on an endorsed prescription but, until 1 October 1999, some of the drugs may not be fully subsidised. Pharmac will be informing prescribers of the details of these changes in the near future. The Ministry of Health has recently alerted practitioners to the possible risk of heart valve damage following the long-term use of weight-loss drugs fenfluramine (Ponderax) and dexfenfluramine (Adifax). All patients who have taken these drugs for longer than 3 months should have a clinical check and, if any abnormality is detected, should be referred to a cardiologist. If mild or greater aortic or mitral regurgitation is present, antibiotic prophylaxis against endocarditis is recommended.--Boyd A Swinburn, Medical Director, National Heart Foundation.