JAC Advance Access originally published online on April 19, 2006
Journal of Antimicrobial Chemotherapy 2006 57(6):1023; doi:10.1093/jac/dkl118
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Editorial |
Another set of endocarditis guidelines?
Journal of Antimicrobial Chemotherapy 11 The Wharf, 16 Bridge Street, Birmingham B1 2JS, UK
*Corresponding author. Tel: +44-121-633-0415; Fax: +44-121-643-9497; E-mail: jac{at}bsac.org.uk
In this issue of the Journal, the British Society for Antimicrobial Chemotherapy publishes its revised guidelines for the prevention of endocarditis.1 These guidelines differ significantly not only from previous versions, but also from current guidelines published by other organizations such as the British Cardiac Society.2
So why has the BSAC decided to break away from convention?
First, guidelines should be evidence based, and there is good evidence that any bacteraemia generated by dental procedures is not significant enough to put susceptible individuals at increased risk of endocarditis.3 The BSAC Working Party then looked at the potential consequences of endocarditis in ‘at risk’ individuals and decided that antibiotic prophylaxis for dental procedures could be justified, but only for those patients in whom endocarditis would carry a greater morbidity and mortality.
Second, the medical community seems to be largely aware of the perceived risks of endocarditis following dental surgery, yet is less aware of the risks generated by other procedures. For example, procedures involving the genito-urinary system carry a risk of bacteraemia with enterococci, which are equally likely to cause endocarditis as oral streptococci, but are much more difficult to treat.
The BSAC Working Party has accepted that patients or their carers may be confused by changes in advice surrounding the use of prophylactic antibiotics, particularly for dental procedures, and has included a suggested patient information leaflet with its guidelines.
The potential for confusion still remains, and for the UK a lead from the Department of Health would be welcome.
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References
1
Gould FK, Elliott TSJ, Foweraker J, et al. (2006) Guidelines for the prevention of endocarditis: report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 57:1035–42.
2 Ramsdale DR and Turner-Stokes L. (2004) Advisory Group of the British Cardiac Society Clinical Practice Committee. Prophylaxis and treatment of infective endocarditis in adults: a concise guide. Clin Med 4:545–50.[Web of Science][Medline]
3 Oliver R, Roberts GJ, Hooper L. (2006) Penicillins for the prophylaxis of bacterial endocarditis in dentistry. Cochrane Database Syst Rev Issue 1.
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  D. Shanson Comment on: Guidelines for the prevention of endocarditis: report of the Working Party of the British Society for Antimicrobial Chemotherapy J. Antimicrob. Chemother., October 1, 2006; 58(4): 895 - 895. [Full Text] [PDF]
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