The Prophylaxis of Subacute Bacterial Endocarditis*

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SUBACUTE bacterial endocarditis consists essentially of a bacterial infection superimposed on previously damaged heart valves or on a congenital cardiac anomaly. The condition formerly was almost invariably fatal but treatment with penicillin and other antibiotic agents now results in the cure of 75 per cent or more of all patients. Certain cases, however, fail to respond, and in others serious or fatal congestive heart failure develops during the course of treatment or within a few weeks after completion of antibiotic therapy. It is important, therefore, that everything possible be done to prevent the occurrence of the disease.

It is known that dental extractions often are followed by transient bacteremia1 and that in persons with rheumatic valvular disease or congenital cardiac anomalies, this not infrequently results in the development of subacute bacterial endocarditis. There is evidence also that the incidence of bacteremia can be reduced appreciably by the administration of penicillin prior to extractions.1 Several observers have recommended that all patients who have rheumatic or congenital heart disease and who require dental extraction, tonsillectomy or irrigation of nasal sinuses receive penicillin as a preventive measure against the development of bacterial endocarditis. The present study was undertaken to ascertain what additional situations may be considered indications for the use of antibiotic agents for this purpose.

Material and Results

A series of 111 consecutive cases of subacute bacterial endocarditis was analyzed with particular reference to the type of pre-existing heart disease and to the event that appeared to have afforded entry of the. . .



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