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September 17, 1982

Treatment of Infective Endocarditis

JAMA. 1982;248(11):1396. doi:10.1001/jama.1982.03330110080044

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Endocarditis possesses a mystique few other diseases in clinical medicine have. I recall a time—not very many years ago—during my residency training when a practicing internist told me of a patient with bacterial endocarditis for whom he was caring in his community hospital. I thought patients with such fascinating conditions were shunted to gargantuan medical centers in the metropolis! Of course, my naiveté disappeared when I entered the "real world" of medical practice and learned how commonly questions about endocarditis arise.

Although the disease has fascinated physicians for years, its changing nature requires periodic reassessment. There has been a profound alteration in the type of patient in whom the infection develops, from the young person with rheumatic valvular disease to the elderly with degenerative or calcific valvular changes, patients with mitral valve prolapse, intravenous drug users, persons with prosthetic valves—groups presenting problems not even envisioned in the days of Osier.