Antibiotic prophylaxis of infective endocarditis in the United Kingdom and Europe

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Abstract
In the U.K. and Europe there are now simple oral chemoprophylaxis recommendations which are likely to be widely complied with by patients, dental and medical practitioners. The main recommendations of the 1982 BSAC Endocarditis Working Party report and the 1985 report of the European Society of Cardiology are similar and involve the administration of a single 3 g dose of oral amoxycillin 1 h before the procedure, or two doses of erythromycin for patients allergic to penicillin. Amoxycillin is more suitable than penicillin V for single dose chemoprophylaxis because of its higher and more persistent serum bactericidal concentrations and lower serum protein binding compared with penicillin V. Controversies about the precautions needed for patients with prosthetic valves are discussed. Erythromycin is associated with more frequent gastrointestinal side-effects and less reliable absorption than amoxycillin. None the less, recent studies suggest that the 1.5 g loading dose of oral erythromycin stearate has an ‘immediate’ effect in reducing post-extraction streptococcal bacteraemia and appears to be reasonably well tolerated by most adults. In 1986 a few changes have been suggested by the BSAC Endocarditis Working Party and concern the use of alternative oral amoxycillin regimens for patients requiring general anaesthesia, the giving of two administrations of amoxycillin within one month when prophylaxis is required for repeated dental procedures and the slower infusion of intravenous vancomycin to reduce the incidence of adverse reactions. A register of cases of failed chemoprophylaxis' has been started in the U.K. and also in Europe.

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