RECOGNITION, MANAGEMENT AND PROPHYLAXIS OF ENDOCARDITIS

Infective endocarditis (IE) remains a disease with high morbidity and mortality. In recent years, a higher frequency of IE has been observed in the elderly, in intravenous drug users and in patients with prosth etic valves. The diverse manifestations of this disease demand a high degree of suspicion from the practitioner, in order to make an early d iagnosis. Advances in and increasing use of echocardiography (especial ly transoesophageal) allow us to identify valvular changes earlier and more precisely. The use of the new Duke's diagnostic criteria, based on clinical manifestations and microbiological and echocardiographic f indings, facilitates the diagnosis and categorisation of IE. An increa se in staphylococci and other problem pathogens, such as penicillin-re sistant streptococci, enterococci resistant to beta-lactams, aminoglyc osides and methicillin-resistant staphylococci has been observed. Impo rtant changes have also taken place in the management of IE. There is a clear trend towards the use of shorter treatment courses, oral and o nce-daily regimens and outpatient programmes, all of which aim to redu ce costs and provide patients with improved quality of life. Antibioti c prophylaxis for the prevention of IE is still controversial. In the past few years more rational regimens have been used, and indications are now more precise. In spite of all this, however, few cases are pre vented and patient compliance to the prophylaxis regimens remains low.