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July 1986

Antibiotic Prophylaxis Against Bacterial Endocarditis in Patients Undergoing Dermatologic Surgery

Author Affiliations

From the Departments of Dermatology, New England Medical Center, Tufts University (Drs Wagner, Grande, and Feingold); and Boston University School of Medicine (Dr Wagner), Boston.

Arch Dermatol. 1986;122(7):799-801. doi:10.1001/archderm.1986.01660190077019

Bacterial endocarditis is an infection with substantial morbidity and mortality. Since only about 15% of all cases of endocarditis can be associated with previous dental, medical, or surgical manipulation, the recommendations for antibiotic prophylaxis against endocarditis have been surrounded by controversy and uncertainty.1 Controlled clinical investigation of prophylaxis against endocarditis is no longer possible due to both ethical considerations and the prohibitively large patient number necessary to achieve significant results. In the absence of hard data, recommendations for antibiotic prophylaxis must be deduced from knowledge that bacteremia accompanies certain surgical procedures and that certain cardiac lesions predispose to bacterial endocarditis. Prophylaxis against endocarditis is generally recommended in patients at high risk for dental, urologic, gastrointestinal tract, gynecologic, throat, and intracardiac surgery because of, for the most part, lesions involving manipulation or incision of mucosal surfaces. Scant attention has been given to the issue of antibiotic prophylaxis for bacterial endocarditis