Current issues in prevention of XXXX .

@entity1 @entity883 @entity114 @entity3454 @entity299 @entity2259 @entity884
Prevention of @entity884 continues to concern health care providers in many specialties. The well-known lack of primary clinical trials in this area is not expected to change. Therefore, the evolution of recommendations and practice must be based on theoretic considerations and continuing assessment of secondary sources of information. Recent developments include a report of 52 cases in which antibiotic prophylaxis for @entity884 was attempted but appeared to fail. Most of these @entity1 had undergone dental procedures after oral @entity114 prophylaxis, with subsequent development of @entity883 . In two thirds, the organism was sensitive to the antibiotic used. Notably, the most common underlying @entity299 among these @entity1 was @entity3454 . However, two recent independent analyses have concluded that providing @entity884 prophylaxis for all @entity1 with @entity3454 during procedures that might cause @entity2259 would not be cost-effective. This is primarily because @entity3454 is common and @entity884 is relatively rare, resulting in an adverse risk-benefit ratio. Parenteral prophylaxis for @entity3454 might even cause a net loss of life from anaphylaxis. On the other hand, for the individual @entity1 or physician, the reassurance provided by attempted prophylaxis with oral @entity114 can be purchased at low cost and low risk. Very few cases of @entity884 have been reported after gastrointestinal and other endoscopic procedures; most of these do not need antibiotic coverage. Prophylactic antibiotics should be restricted to those situations in which both the procedure and the underlying cardiac condition seem to pose significant risk, for example, endoscopic sclerotherapy of esophageal varices in @entity1 with prosthetic heart valves. Newly revised recommendations have been issued by the Medical Letter, the American Heart Association, and the American Dental Association. These regimens are shorter and simpler than earlier versions.
