Bacterial endocarditis continues to cause high morbidity and mortality and often occurs in the setting of structural abnormalities of the cardiovascular system. Alterations of the normal heart valvular function increase the risk for that valve to become the site of a bacterial nidus. Patients with valve replacement, rheumatic valvular disease, or congenital heart malformations are among those at highest risk. Many medical, surgical, and dental procedures result in significant short-term bacteremia that places such patients at risk for infecting their heart valves. It is not a new concept that an antimicrobial agent present in the blood during the time a procedure-induced bacteremia occurs might prevent infective endocarditis. The American Heart Association (AHA), Dallas, Tex, issued its guidelines for prevention in 1965 with revisions in 1972, 1977, and 1984.13 The most recent revision of these recommendations appeared December 12, 1990, in the Journal of the American Medical Association.4 The
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