Physicians’ recommendations to patients for use of antibiotic prophylaxis to prevent endocarditis

Abstract

The American Heart Association recommendations for infectious endocarditis (IE) prophylaxis, published in June 1997, sought to improve patient and physician compliance by simplifying the dosing regimen and clarifying endocarditis risk. (Ophthalmic procedures were not addressed in this 1997 document but are not generally considered to require prophylaxis). Adherence to these updated recommendations in patients with echocardiographic verification of their endocarditis risk profile is unknown. The authors sought to determine the recommended and actual use of IE prophylaxis as reported by patients undergoing echocardiography. All patients who underwent outpatient transthoracic echocardiography at a university-based tertiary hospital in Boston during December 1997 were contacted 6 to 9 months later to respond to a survey, completed by 218 (80%) eligible subjects. One hundred eight patients (49.5%) had clinical or echocardiographic findings for which prophylaxis was indicated. Of these 108 patients, 71 (65.7%) reported that they were instructed to take IE prophylaxis. Sixteen high-risk patients (88.9%) but only 55 moderate-risk patients (61.1%) reported that they were instructed to take prophylaxis. Among the 110 negligible-risk patients, 29 (26.4%) reported that they had been instructed to take IE prophylaxis. Overall, 100 patients (45.9%) reported that they received physician instructions to take IE prophylaxis. Of those who subsequently underwent a procedure for which IE prophylaxis was indicated (n = 68), 9 (13.2%) elected not to follow their physician’s advice to take prophylaxis. The authors conclude that although most patients reported receiving instructions for IE prophylaxis use consistent with American Heart Association guidelines, IE prophylaxis overuse among negligible-risk patients and underuse among moderate-risk patients was common. Continued physician and patient education may lead to improved adherence to the current American Heart Association recommendations.—Thomas J. Liesegang