抗生素预防感染性心内膜炎的研究进展

Progress in Antibiotic Prophylaxis of Infective Endocarditis

综述英国抗菌化学治疗学会(BSAC)、美国心脏协会(AHA)、欧洲心脏病学会(ESC)、英国心脏学会(BCS)等最近发布的感染性心内膜炎(IE)预防指南。由于尚无证据表明口腔科操作或手术时预防应用抗生素有益,因此,BSAC建议,在进行所有口腔科操作时,仅对IE高危患者给予抗生素预防:成人术前1h一次给予口服阿莫西林3g;对青霉素过敏者,术前1h一次给予口服克林霉素600mg。在进行泌尿生殖道、胃肠道、呼吸道及妇产科手术或操作时,对IE中高危患者联合应用阿莫西林及庆大霉素,术前或诱导麻醉时给药;对青霉素过敏者,联合应用替考拉宁及庆大霉素。

This paper reviewed the current Guidelines on the Ttreatment of Infective Endoearditis produced by the British Society for Antimicrobial Chemotherapy （BSAC）, the American Heart Association （AHA）, European Cardiac Society （ESC）and British Cardiac Society （BCS）. Because of the inadequate evidenoes of the benefit produeed by the antibiotic applications in the prevention of infective endoearditis associated with dental procedures or operations, BSAC recommends that antibiotic prophylaxis should be applied only to those patients in whom the risk of developing infective endocarditis is high for all dental procedures. For adult patients, it is reeornmended that a single oral dose of 3 g amoxieillin should be given 1 h prior to the procedure or operation. If the patient has a documented penicillin allergic history, a single dose of oral elindamyein （600 mg）should be administrated 1 h before the procedure or operation. For genitourinary, gastrointestinal, respiratory or obstetrie/gynaecologieal procedures or operation in the patients at moderate- high risk of infective endocarditis, it is recommended that a combination of ampieillin or amoxieillin and gentamiein should be administrated just before the operation or at induction time of anaesthesia. If the patient has a documented penidllin allergic history, a combination of tdooplanin and gentamidn should be preseribed.