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[Prophylaxis of bacterial endocarditis].

An effective prophylaxis against bacterial endocarditis is necessary in patients at risk. In all medical specialities, a lack of information about the importance concerning an antibiotic prophylaxis of bacterial endocarditis remains. Among other institutions the American Heart Association has updated recommendations for the prevention of bacterial endocarditis in order to more clearly define when prophylaxis is or is not recommended, improve practitioner and patient compliance, and reduce cost as well as potential side effects.

Adult↗

Fungal endocarditis complicating treatment of prosthetic valve bacterial endocarditis: value of prophylactic oral nystatin.

We describe two patients in whom fungal endocarditis occurred during antibiotic therapy for prosthetic valve bacterial endocarditis. Successful management of both patients was eventually achieved with antifungal therapy and replacement of the prosthetic valves. These cases and review of the literature suggest that (1) high-dose antibacterial therapy predisposes to fungal endocarditis; (2) during prolonged antibiotic therapy in patients predisposed to endocarditis, clinicians should consider the use of oral nystatin as prophylaxis against fungemia and possible fungal endocarditis; and (3) early replacement of prosthetic valves infected with fungi is indicated because chemotherapy alone is predictably inadequate to effect a cure.

Adult↗

Subarachnoid hemorrhage--the initial manifestation of bacterial endocarditis. Report of a case with negative arteriography and computed tomography.

The case of a patient who suffered a nontraumatic subarachnoid hemorrhage (SAH) associated with normal angiography is reported. Three weeks later he developed an embolic stroke secondary to a nonhemolytic Staphylococcus epidermidis endocarditis of the mitral valve; thus, the SAH was the initial manifestation of bacterial endocarditis. Bacterial endocarditis should be considered a possible cause of SAH, especially in the 7% of patients with angiographically negative SAH.

Adult↗