Failure of Prophylaxis for Bacterial Endocarditis: American Heart Association Registry

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To the editor: The American Heart Association (AHA) recognizes that its current recommendations for antibiotic prophylaxis are necessarily empiric (1). This situation has arisen because important clinical information on the efficacy of antibiotic prophylaxis of bacterial endocarditis is lacking. The present recommendations are therefore based upon secondary sources of information such as the relative propensity of various procedures to cause bateremia, in-vitro studies of bacteria recovered from the blood, the effect of antibiotics on bacteremias, the susceptibility of various heart lesions to infection, anecdotal case reports, and study of experimental models.

Although more than 30 individual cases of apparent prophylaxis

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