Management of bacterial endocarditis-1970

Bacterial endocarditis continues to be an important and challenging problem. Diagnosis depends upon consideration of this entity in patients with unexplained fever with or without the presence of heart murmurs and evidence of embolic lesions. Five blood cultures will document the presence of a more or less continuous bacteremia. Treatment depends upon selection of the appropriate antibiotic by disc or tube dilution sensitivity studies, or both. Optimal dosage can be documented by serum bactericidal levels. Duration of treatment on an empirical basis is outlined. Special problems including penicillin allergy, culture-negative endocarditis and endocarditis caused by fungi and gram-negative bacilli are discussed. The role of surgery in acute bacterial endocarditis is reviewed. Endocarditis affecting prosthetic valves is discussed along with current recommendations for prevention and treatment of this increasing problem. The role of antibiotic prophylaxis is discussed.