Historical perspectives Inthe American Heart Association AHA was the first medical society to establish the need for a prophylactic antibiotic regimen to prevent infective endocarditis IE in at-risk patients undergoing various surgical procedures, including tooth extractions and other dental manipulations that affect the gum.
In the pre-antibiotic era, reports based on clinical observations described cases of IE of streptococcal aetiology in which there was a history of professional dental manipulation.
The AHA Committee on the Prevention of Rheumatic Fever and Bacterial Endocarditis concluded that patients undergoing dental procedures must be protected by high concentrations of antibiotic present in the blood at the time of the procedure. Penicillin administered parenterally was preferred, although oral penicillin V was introduced as second choice.
|Introduction||A cohort study conducted in the USA and involving twins and siblings with CF retrospectively analyzed APEs in 1, patients, comparing the FEV1 outcomes of approximately 5, courses of intravenous antibiotics administered in the hospital with those of the same number of courses administered in the home, and concluded that there was no difference in functional outcome between the two approaches LE 2b.|
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|Background||Abstract Background As bacterial infections provoke exacerbations, COPD patients may benefit from prophylactic antibiotics.|
|Infectious Agents as Tools of Mass Casualties Historically, outbreaks wars of microbial species against the human species have killed far more people than war itself.|
In cases of sensitivity to penicillin, other antibiotics such erythromycin or tetracycline were recommended [ 2 ]. Since that time, the scientific community has universally accepted the need for antibiotic prophylaxis in patients susceptible to developing IE.
Experimental models developed in the s provided evidence of the efficacy of prophylaxis in animals and demonstrated the ability of antibiotics to prevent Streptococcus sanguinis endocarditis [ 3 ].
However, the different antibiotic regimens to prevent IE in dental patients were developed based on empirical criteria. Inthe British Society for Antimicrobial Chemotherapy included amoxicillin in the prophylactic antibiotic regimen against IE [ 4 ].
Amoxicillin has a broad antibacterial spectrum and a more favourable pharmacokinetic profile than penicillin V for oral administration; this has made it the drug of choice in all current guidelines on the use of antibiotics to prevent IE.
The campaigns for the prevention of rheumatic fever, the increase in the prevalence of intravenous drug abuse and the growth in cardiovascular interventions have transformed the microbiological patterns of IE, with a relative decrease in the incidence of streptococcal endocarditis and a significant increase in endocarditis due to staphylococci and other less common organisms.
These changes make it difficult to draw reliable epidemiological conclusions on the efficacy of antibiotics for the prevention of IE. In general, the majority of studies indicate that, despite the universal implantation of antibiotic prophylaxis prior to the dental treatment, no global reduction in the prevalence of IE has been achieved [ 5 ].
This has been one of the main arguments put forward by the British health authorities to revoke the indications for antibiotic prophylaxis in patients undergoing dental, digestive tract or genitourinary interventions.
This scepticism of the British health authorities to the prophylactic efficacy of antibiotics in IE is not shared by other scientific societies, which continue to include antibiotic cover for dental procedures in patients at risk of developing IE.
Epidemiological observations and statistical analyses made after the cessation of prophylaxis in the United Kingdom suggest the need for antibiotic cover in patients at maximum risk of IE of poor prognosis.
In this setting, current guidelines maintain the need for prevention for patients considered to be at high risk of developing IE, such as individuals with prosthetic heart valves, the presence of certain congenital cardiopathies and patients who have had a previous episode of IE.
Impact of the nice recommendations In the controversial document published inNICE brought about the complete cessation of antibiotic prophylaxis for all patients at risk of IE undergoing dental interventions [ 6 ].
The main premises on which the British experts based this decision was the quantifiable risk of antibiotic administration to the individual patient, the potential appearance of unnecessary antimicrobial resistance and the economic analysis of the cost-effectiveness of prophylaxis. The recommendation was based on the limited available evidence on antibiotic prophylaxis as an effective method to reduce the incidence of IE when given before an interventional procedure.
Furthermore, the existence of transient bacteraemia during activities of daily living, such as toothbrushing or chewing, diminishes the significance of dental procedures as a cause of IE, making antibiotic prophylaxis virtually ineffective for preventing the disease.
Consequently, NICE did not recommend antibiotic prophylaxis against IE in persons undergoing dental procedures or digestive, respiratory or genitourinary tract interventions, except for manipulations at an infected non-dental site. The expert committees across the rest of the world, including the AHA and the European Society of Cardiology ESChave continued to recommend antibiotic prophylaxis in high-risk individuals, and these protocols are followed by most cardiologists and cardiac surgeons.
The first studies on the epidemiological repercussions of the implementation of the NICE guideline showed a substantial reduction in the prescription of antibiotics in its area of influence and the data gathered showed no significant changes in the general upward trend in cases of IE [ 7 ].
Ina case of IE was reported in which aetiological analysis suggested a very strong association with a previous dental intervention performed without antibiotic cover. The affected patient had a metallic aortic valve and developed a fatal episode of S.Feb 11, · The use of azithromycin in CF patients chronically infected with P.
aeruginosa causes slight improvement in pulmonary function, reduces the frequency of APEs, and has no significant side effects (LE 1; GR A).cepacia complex, Achromobacter xylosoxidans, Aspergillus spp., etc.e efficacy and safety of azithromycin.
However, as the improvements in total SGRQ score did not reach a clinically significant level, further research is needed to explore the influence of prophylactic antibiotic use on quality of . The bacteriological efficacy against clinically isolated 41 strains was 35 eradicated, 1 decreased, 2 persisted and 3 replaced, the eradication rate being %.
The use of newer macrolides, e.g. azithromycin, may be associated with a reduced risk of cardiac arrhythmias than use of older macrolides, e.g. erythromycin and clarithromycin 82–84, and may, therefore, be the drug of choice.
Zpack ® – 5-day formulation. The 5-day formulation of azithromycin was the original formulation introduced in the US. At the time of its introduction most acute exacerbations of chronic bronchitis were treated with antimicrobial agents such as tetracyclines, beta lactams, and sulfa drugs.
Animal research continues to be very useful for the preliminary evaluation of the efficacy and safety of drugs, and studies are being performed on the usefulness of other, alternative drugs to antibiotics for the prevention of IE in at-risk patients.