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Article
April 3, 1991

Prevention of Bacterial Endocarditis-Reply

Author Affiliations

For the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the American Heart Association Dallas, Tex

For the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the American Heart Association Dallas, Tex

JAMA. 1991;265(13):1688. doi:10.1001/jama.1991.03460130078021
Abstract

In Reply.—  No recommendations can cover all possible groups or situations. Neurogenic bladder dysfunction treated with long-term intermittent catheterization is a special situation for which prophylaxis is not recommended. The frequency of catheterization and the large variety of bacterial species that may be present in the bladder make prophylaxis impossible to accomplish in this situation. Continuous proxphylaxis during intermittent catheterization would promote the emergence of resistant organisms. Symptomatic urinary tract infection should be treated when it occurs.Concerning the letter from Stierer and Sterchele and the letter from McMorrow and Nahata, we offer the following comments: In the previous recommendations from the American Heart Association concerning bacterial endocarditis prophylaxis,1 the regimen for erythromycin in patients who are allergic to penicillin was 1.0 g, followed by 500 mg, without reference to a specific preparation of the drug. Because of the complex pharmacokinetics associated with various erythromycin preparations, as well as

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