| Antibiotic prophylaxis for infective endocarditis: ethical care in the era of revised guidelines. | |
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MedLine Citation:
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PMID: 21088660 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Beginning in 1955, the American Heart Association recommended antibiotic prophylaxis among patients with certain structural heart diseases to decrease the likelihood of infective endocarditis (IE) following dental procedures. Over the ensuing 52 years, the American College of Cardiology/American Heart Association (ACC/AHA) guidelines were revised to address gastrointestinal and genitourinary procedures and to modify the assessment of relative risks and specific regimens for prophylaxis. Throughout the various revisions, prophylaxis was recommended for individuals who were at increased risk of developing IE based on best evidence and consensus opinion, albeit in the absence of randomized controlled trials. In 2007, the AHA published a revised guideline statement dramatically restricting its recommendations for antibiotic prophylaxis against IE. In 2008, these views were incorporated in an ACC/AHA guideline update on the management of patients with heart valve disease. The revisions represent a dramatic shift in terms of the patients for whom antibiotic prophylaxis is recommended and the procedures for which it is recommended. What is striking about the new guidelines is that the change in recommendations was based not on new data, but on a change in philosophy despite the lack of new data. To some degree, the arguments for and against antibiotic prophylaxis become those of philosophy, ethics, and the role of evidence-based medicine. This manuscript attempts to briefly examine those arguments and discuss why the revised guidelines may fail to respect the ethical principles of beneficence and patient autonomy. |
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Authors:
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David S Bach |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Methodist DeBakey cardiovascular journal Volume: 6 ISSN: 1947-6094 ISO Abbreviation: Methodist Debakey Cardiovasc J Publication Date: 2010 Nov-2011 Jan |
Date Detail:
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Created Date: 2010-11-22 Completed Date: 2011-01-21 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101508600 Medline TA: Methodist Debakey Cardiovasc J Country: United States |
Other Details:
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Languages: eng Pagination: 48-52 Citation Subset: IM |
Affiliation:
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University of Michigan, Ann Arbor, Michigan, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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American Heart Association Animals Antibiotic Prophylaxis / ethics* Attitude of Health Personnel Endocarditis / etiology, prevention & control* Evidence-Based Medicine / ethics Guideline Adherence / ethics* Health Knowledge, Attitudes, Practice Humans Patient Education as Topic / ethics Patient Selection / ethics Personal Autonomy Practice Guidelines as Topic* Risk Assessment Risk Factors United States |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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