ABSTRACT
PURPOSE: Patients with a history of allergic reaction to penicillin, but with no detectable specific IgE, are common and pose a dilemma. Challenge tests are considered to be the diagnostic gold standard. The aim of this study was to identify subgroups of patients with very low risk for reactions who could be safely tested using a more rapid and simple procedure. METHODS: A total of 580 consecutively referred adult patients with a history of non-serious cutaneous allergic reactions to penicillin, but with no IgE, were challenged with therapeutic doses of penicillin V (phenoxymethylpenicillin), penicillin G (benzylpenicillin), or both. RESULTS: Only 14 of 580 patients had a positive challenge test. In 11 of the 14, a reaction to challenge occurred within 2 hours, and none were anaphylactic. The year of the original reaction was known for 555 patients; a positive challenge was seen in only 0.4% of those with an original reaction >15 years before challenge, but in 4.6% of those with a more recent original reaction (P=0.001). Onset of a reaction within the first day of the original exposure was a predictive factor for a positive challenge (P=0.001) in patients challenged within 15 years of the original reaction. CONCLUSIONS: Among suspected penicillin-allergic patients with non-severe skin reactions and no detectable specific IgE, the subgroup of patients who originally reacted more than 15 years previously had very low risk for reacting to a challenge. The risk was higher in patients with a more recent original reaction, especially if the symptoms had occurred within the first day of exposure.
Subject(s)
Adult , Humans , Drug Hypersensitivity , Exanthema , Hypersensitivity , Immunoglobulin E , Penicillin G , Penicillin V , Penicillins , Risk Factors , SkinABSTRACT
DRESS syndrome (drug reaction with eosinophilia and systemic symptoms), previously named "drug hypersensitivity syndrome", is a severe adverse drug reaction characterized by skin rash, fever, lymph node enlargement and internal organ involvement. We report on a 7-year old girl who developed DRESS syndrome caused by penicillin V treatment.
El síndrome DRESS (así llamado por las indíciales del inglés "drug reaction with eosinophilia y systemic symptoms ") es una reacción a medicamentos, acompañada por eosinofilia y síntomas sistémicos. Conocida anteriormente como "síndrome de hipersensibilidad a los medicamentos, se trata de una reacción adversa severa a los medicamentos, caracterizada por erupción cutánea, fiebre, agrandamiento de los ganglios y compromiso de órganos internos. El presente trabajo reporta el caso de una niña de 7 años de edad, que desarrolló el síndrome DRESS a partir de un tratamiento con penicilina V.
Subject(s)
Child , Female , Humans , Anti-Bacterial Agents/adverse effects , Drug Eruptions/etiology , Eosinophilia/chemically induced , Fever/chemically induced , Lymphatic Diseases/chemically induced , Penicillin V/adverse effects , Diagnosis, Differential , Drug Eruptions/diagnosis , Drug Hypersensitivity , Eosinophilia/diagnosis , Fever/diagnosis , Lymphatic Diseases/diagnosis , Pharyngitis/drug therapy , Syndrome , Tonsillitis/drug therapyABSTRACT
OBJETIVO: Avaliar a adesão a antibiótico profilático em crianças com anemia falciforme. MÉTODOS: Estudo prospectivo de 108 crianças (idade entre 3 meses e 4,5 anos, 45 por cento masculino) seguidas por 15 meses no Hemocentro de Belo Horizonte. Avaliou-se a adesão por meio de três entrevistas com cuidadores, análise de prontuário médico e atividade antibacteriana em uma amostra de urina em 81 crianças. Os antibióticos foram dispensados gratuitamente. RESULTADOS: Penicilina foi usada em 106 casos (maioria via oral), e eritromicina, dois casos. O antibiótico foi detectado na urina de 56 por cento das crianças; 48 por cento dos cuidadores afirmaram nas entrevistas que nenhuma dose deixou de ser administrada; em 89 por cento dos prontuários médicos, não se registrou falha de adesão. Considerando-se aderente a criança que não apresentasse falhas em nenhum ou em apenas um dos métodos, a taxa de adesão foi de 67 por cento. O grau de concordância entre os três métodos para medir a adesão foi baixo. Não se demonstrou qualquer associação entre a taxa de adesão e o gênero, estado nutricional, renda familiar per capita, nível educacional dos cuidadores ou número de membros da família. CONCLUSÕES: A taxa de adesão à antibioticoterapia profilática foi baixa quando avaliada por meio de questionários e testes urinários, e superestimada quando avaliada pela consulta ao prontuário médico. A adesão deve ser preferencialmente avaliada por vários métodos, pois sua mensuração é complexa. Os resultados do presente estudo sugerem a necessidade de programas educacionais abrangentes para os profissionais de saúde, para as famílias e crianças portadoras de anemia falciforme.
OBJECTIVE: To prospectively assess compliance with antibiotic prophylaxis among children with sickle cell anemia. METHODS: A total of 108 children (aged 3 months to 4½ years, 45 percent male) were recruited from the Hematology Center in Belo Horizonte, Brazil, and followed up for 15 months. Data on compliance were obtained from three interviews with the primary caregivers, from the children's medical records and from assay of antibacterial activity in urine samples of 81 children. Antibiotics were available free of charge. RESULTS: Penicillin was used in 106 cases (majority by oral route); erythromycin in 2 cases. Urine samples tested positive for the antibiotic in 56 percent of the cases; 48 percent of the caregivers assured during interviews that all doses had been administered to children; 89 percent of medical files recorded no compliance failures. Considering a child compliant if none or just one of these methods detected missing doses, the rate of compliance was 67 percent. The agreement between methods for assigning a child as compliant or not was low. No significant association of compliance rate with gender, nutritional status, per capita income of the family, caregivers' schooling, or number of family members was demonstrated. CONCLUSIONS: Compliance rate with prophylactic antibiotic therapy was low when assessed by interviews and urine tests; and overestimated by analysis of medical records. Compliance should preferably be assessed by several methods due to the complex character of its measurement. The results of the present study suggest a need for a comprehensive educational program involving healthcare professionals, families and children with sickle cell anemia.
Subject(s)
Child, Preschool , Female , Humans , Infant , Male , Antibiotic Prophylaxis , Anemia, Sickle Cell/complications , Medication Adherence/statistics & numerical data , Penicillins/therapeutic use , Anti-Bacterial Agents/therapeutic use , Brazil , Caregivers , Drug Administration Schedule , Erythromycin/therapeutic use , Interviews as Topic , Nutritional Status , Patient Education as Topic , Prospective Studies , Penicillin G Benzathine/therapeutic use , Penicillin V/administration & dosage , Penicillin V/therapeutic useABSTRACT
La clindamicina es un antibiótico de amplio espectro con actividad contra los aerobios grampositivos y una extensa gama de bacterias anaerobias, entre ellas los patógenos productores de betalactamasa. Los estudios in vitro e in vivo han demostrado que este fármaco alcanza una concentración elevada en el punto de infección, reduce la virulencia de las bacterias y refuerza las actividades fagocíticas de los linfocitos inmunitarios del huésped. La clindamicina por vía oral se absorbe con rapidez y eficacia, y su concentración permanece por encima de la concentración inhibidora mínima de la mayoría de los organismos por lo menos durante 6 horas. En este análisis, presentaremos pruebas de la eficacia e inocuidad de la clindamicina en el tratamiento de las infecciones odontogénicas con datos de estudios preclínicos y clínicos, los cuales avalan la aplicación general de este antibiótico como antiinfeccioso en el campo de la odontología.
Clindamycin is an antibiotic of wide range of action with a great activity against aerobic gram-positive germs and a broad spectrum of anaerobic bacteria, among which we can find the pathogenic agents that produce Beta-lactamase. The in vitro and in vivo have shown that this medicine reaches a high concentration at the infection point, reduces the bacteria virulence, and strengthens the phagocytic activity of the immunizing lymphocyte of the host. Clindamycin through oral ingestion is absorbed very quickly and effectively, and its concentration remains the same above the minimum inhibitory concentration of most of the organisms at least for six hours. In this analysis, we will introduce some proofs about the effectiveness and innocuousness of clindamycin in the treatment of odontogenic infections. This data is based upon clinical and pre-clinical studies that support the general use of this mentioned antibiotic as an anti-infectious agent in the field of odontology.
Subject(s)
Clindamycin/pharmacology , Clindamycin/therapeutic use , Focal Infection, Dental/diagnosis , Focal Infection, Dental/therapy , Ampicillin/therapeutic use , Periodontal Diseases/therapy , Research Report , Penicillin V/therapeutic use , Dental Prophylaxis , Data Interpretation, StatisticalABSTRACT
BACKGROUND: Anti-IgE mAb which binds circulating but not receptor-bound IgE has been shown to be effective in treatment for asthma and other allergic diseases. However, the mechanisms by which anti-IgE mAb influences the pathophysiological responses are remained to be illustrated. This study was undertaken to examine the therapeutic efficacy of non-anaphylactogenic anti-mouse IgE mAb using murine models of IgE-induced systemic fatal anaphylaxis. METHODS: Active systemic anaphylaxis was induced by either penicillin V (Pen V) or OVA and passive systemic anaphylaxis was induced by either anaphylactogenic anti-mouse IgE or a mixture of anti-chicken gamma globulin (CGG) IgG1 mAb and CGG. The binding of the Fc portion of anti-IgE to CHO-stable cell line expressing mouse FcgammaRIIb was examined using flow cytometry. Fc fragments of anti-IgE mAb were prepared using papain digestion. The expression of phosphatases in lungs were assessed by Western blotting and immunohistochemistry. RESULTS: Anti-IgE mAb prevented IgE- and IgG-induced active and passive systemic fatal reactions. In both types of anaphylaxis, anti-IgE mAb suppressed antigen-specific IgE responses, but not those of IgG. Anti-IgE mAb neither prevented anaphylaxis nor suppressed the IgE response in FcgammaRIIb-deficient mice. The Fc portion of anti-IgE mAb was bound to murine FcgammaRIIb gene-transfected CHO cells and inhibited systemic anaphylaxis. Anti-IgE mAb blocked the anaphylaxis-induced downregulation of FcgammaRIIb-associated phosphatases such as src homology 2 domain-containing inositol 5-phosphatase (SHIP) and phosphatase and tensin homologue deleted on chromosome ten (PTEN). CONCLUSION: Anti-IgE mAb prevented anaphylaxis by delivering nonspecific inhibitory signals through the inhibitory IgG receptor, FcgammaRIIb, rather than targeting IgE.
Subject(s)
Animals , Cricetinae , Mice , Anaphylaxis , Asthma , Blotting, Western , Cell Line , CHO Cells , Digestion , Down-Regulation , Flow Cytometry , gamma-Globulins , Immunoglobulin E , Immunoglobulin Fc Fragments , Immunoglobulin G , Immunohistochemistry , Inositol , Lung , Ovum , Papain , Penicillin V , Phosphoric Monoester HydrolasesABSTRACT
Primary actinomycosis of the abdominal wall is a rare clinical entity. Only 7 adequately described cases have been reported in the English literature. We report a case of isolated abdominal wall actinomycosis involving the left lower quadrant of the abdominal wall in a 32-year-old diabetic male. The diagnosis was confirmed by histopathological examination. Surgical drainage of the abscess followed by long-term administration of penicillin resulted in cure. The clinicopathological spectrum of actinomycosis is reviewed and isolated involvement of the abdominal wall is characterized in light of the knowledge acquired from the available literature on this rare clinical presentation. The significance of obtaining tissues for culture and histopathology in all inflammatory lesions is emphasized
Subject(s)
Humans , Male , Abdominal Muscles , Actinomyces , Actinomycosis/drug therapy , Penicillin V , Actinomycosis/surgeryABSTRACT
No início de um novo século, questões importantes sobre a pato- gênese e abordagem terapêutica da febre reumática (FR) permanecem sem respostas. Nas últimas décadas, ocorreu uma redução acentuada da freqüência da doença nos países desenvolvidos, concomitante à implementação do padrão social, econômico e cultural da população. O reaparecimento da doença em algumas áreas dos países industrializados deve ser considerado como um alerta de sua presença potencial, apesar do aparente controle. Nos países em desenvolvimento, a FR e sua seqüela, a cardiopatia reumática crônica, estão intimamente relacionadas à pobreza e continuam como desafio para todos os profissionais de saúde. Nessas áreas, a FR é a causa mais importante de doença cardíaca adquiri- da, representando um relevante problema de saúde publica, com significativos índices de morbimortalidade. Devido à impossibilidade de modificações dos fatores socioeconômicos em curto prazo, o controle da FR somente poderá ser alcançado através da implantação de programas educacionais e de assistência à saúde, envolvendo decisões políticas e planos de ação para implementar a adesão dos pacientes às profilaxias primária e secundária.
In the beginning of a new century, major questions about the pathogenesis and treatrnent of the rheumatic fever remain unanswered. The frequency of the disease has sharply declined in the developed countries and this fact was concomitant with the improvement in living stan- dardo Its recent resurgence in some areas of the industrialized countries must be considered as a warning for its potential presence, in spire of an apparent control. The rheumatic fever and its sequel, the rheumatic heart disease, are closely related with poverty and are still a challenge to rhose involved in providing health care in developing countries. In those areas, the rheumatic fever is the most importam cause of acquired heart disease and is still a relevant problem of public health with significant rates of morbidity and mortaliry. Owing to the impossibility to change the structural socioeconomic factors in a short time, the control of rheumatic fever can only be achieved by the setting up of healrh and educational programmes, involving political decisions and plans of action to provide better adherence from patients to primary and secondary prophylaxis.
Subject(s)
Humans , Child , Adolescent , Rheumatic Fever/epidemiology , Rheumatic Fever/prevention & control , Socioeconomic Factors , Rheumatic Fever/drug therapy , Penicillin G Benzathine/therapeutic use , Penicillin V/therapeutic use , Sulfadiazine/therapeutic useABSTRACT
La faringitis estreptocóccica es una importante causa de morbilidad y frecuente fuente de mal uso de antimicrobianos. No más de 10 a 15 por ciento de los adultos que consultan por odinofagia aguda y fiebre tiene una faringitis causada por Streptococcus pyogenes. Una terapia innecesaria expone a los pacientes a reacciones alérgicas, otros eventos adversos e incrementos en los costos de salud. En países como Chile, donde la enfermedad reumática ha declinado considerablemente, la confirmación de S. pyogenes por tests rápido o cultivo faríngeo es la aproximación clínica más lógica. Los tests rápidos para diagnóstico etiológico tienen una buena sensibilidad (80 a 90 por ciento) y especificidad (95 a 99 por ciento). Estos tests pueden ser efectuados a un costo razonable y los resultados negativos pueden ser confirmados mediante cultivo. Diversas opciones terapéuticas están disponibles hoy en día para erradicar a S. pyogenes de la faringe, un marcador subsidiario de eficacia en la prevención de enfermedad reumática. Estas alternativas no mejoran significativamente la eficacia obtenida con penicilina V oral, tienen similar frecuencia de eventos adversos y se caracterizan por un significtivo incremento de costos. Por otra parte, los esquemas terapéuticos basados en amoxicilina oral o penicilina G benzatina intramuscular tienen similar costo que el tratamiento estándar. Tratamientos abreviados efectuados con diversos fármacos durante 5 ó 6 días, tienen eficacia similar que esquemas estándares pero no reducen el costo total de tratamiento
Subject(s)
Humans , Adolescent , Adult , Penicillin V , Pharyngitis , Streptococcus pyogenes , Tonsillitis , Administration, Oral , Amoxicillin , Health Care Costs , Penicillin G Benzathine , Penicillin V , Pharyngitis , Pharynx , Streptococcus pyogenes , TonsillitisABSTRACT
Agente: Bacillus anthracis. (Bacilo Gram positivo, aerobio estricto, esporulado, inmóvil). Reservorio: Herbívoros y sus subproductos, ambiente contaminado con esporas. Transmisión: Pasto con esporas ingestión por ganado esporas en carne, subproductos o suelo humano: contacto con piel, epitelio respiratorio, bucofaríngeo o intestinal. Laboratorio: Gram y cultivo en agar sangre de tejidos o líquidos infectados. Prevención: Vacuna y antimicrobianos Tratamiento: Penicilina V oral o g endovenosa, por un plazo variable de al menos 7 a 10 días. Alternativas: eritromicina, cloranfenicol, tetraciclina y ciprofloxacina
Subject(s)
Humans , Animals , Carbuncle/etiology , Bacillus anthracis , Carbuncle/diagnosis , Carbuncle/drug therapy , Carbuncle/transmission , Bacillus anthracis , Bacterial Vaccines , Chile , Disease Reservoirs , Occupational Risks , Penicillin G , Penicillin VSubject(s)
Child, Preschool , Humans , India , Male , Parotitis/diagnosis , Penicillin V/therapeutic use , Penicillins/therapeutic use , Recurrence , SialographyABSTRACT
Podemos concluir que esquemas abreviados de amoxicilina durante 6 días, cefalosporinas orales (cefadroxilo, cefuroxima, cefixima y cefpodoxima) durante 4 ó 5 días y azitromicina o superiores que el tratamiento clásico de la faringoamigdalitis estreptocóccica con fenoximetil penicilina durante 10 días, en términos de eficacia clínica y erradicación bacteriológica
Subject(s)
Humans , Streptococcal Infections/drug therapy , Pharyngitis/drug therapy , Pharyngitis/etiology , Tonsillitis/drug therapy , Tonsillitis/etiology , Amoxicillin/administration & dosage , Amoxicillin/therapeutic use , Azithromycin/administration & dosage , Azithromycin/therapeutic use , Cephalosporins/administration & dosage , Cephalosporins/therapeutic use , Penicillin V/administration & dosage , Penicillin V/therapeutic use , Streptococcus pyogenes/drug effects , Streptococcus pyogenes/pathogenicityABSTRACT
Os autores fazem uma revisäo a respeito dos princípios fundamentais da antibioticoterapia, procurando orientar o cirurgiäo-dentista na utilizaçäo racional dos antibióticos, que säo importantes coadjuvantes no tratamento das infecçöes odontogênicas. Além disso, säo apresentados esquemas antibióticos para serem utilizados em infecçöes leves, moderadas ou severas, visando o uso destes medicamentos de acordo com suas características individuais
Subject(s)
Anti-Bacterial Agents/administration & dosage , Mouth Diseases/therapy , Focal Infection, Dental/microbiology , Focal Infection, Dental/therapy , Amoxicillin/administration & dosage , Clindamycin/administration & dosage , Erythromycin/administration & dosage , Gentamicins/administration & dosage , Metronidazole/administration & dosage , Penicillin G/administration & dosage , Penicillin V/administration & dosage , Penicillins/administration & dosageABSTRACT
Capsaicin, the pungent principle of hot peppers, is a neurotoxin that depletes unmyelinated primary sensory neurons (polymodal nociceptors) of neuropeptides like tachykinins. However, the role of capsaicin-sensitive sensory nerve in the production of cytokines, penicillin V (PEV)-induced active fatal anaphylaxis and other immune responses is not yet fully established. Neonatal mice were pretreated s.c. with a single injection of 10 ug of capsaicin per mouse in volume of 20 ul within 5 days of age. Using 5-8 week old mice pretreated as neonates with capsaicin, the capsaicin- pretreated and vehicle-treated control mice were examined for various parameters of immune responses described above. For the induction of active fatal anaphylaxis with PEV, 8 week old mice pretreated as neonates and age-matched capsaicin- untreated control mice were sensitized i.p. with 500 ug of PEV-ovalbumin conjugate plus 2*10(9) B. pertussis and 1.0 mg alum and challenged i.v. with PEV-bovine serum albumin conjugate 14 days later. It was found that neonatal capsaicin-pretreatment significantly enhanced contact hypersensitivity to TNCB and hemagglutination response to SRBC, but significantly inhibited the proliferation response of rnurine splenocyte to Con A and LPS. Interestingly, neonatal capsaicin pretreatment significantly inhibited the intensity of PEV-induced active fatal anaphylaxis and decreased the mortality due to anaphylactic shock. It also significantly inhibited LPS- induced production of cytokines such as TNF-a, IL-1B, IL-6, IL-10, and IL-12. The capsaicin-pretreatment also resulted in an inhibition of the activation of NF-kB. Taken together, these data showed for the first time that neonatal capsaicin-pretreatment significantly inhibited an antibiotic (PEV)-induced anaphylaxis and production of various cytokines, and suggest that capsaicin-sensitive primary sensory nerve may play an important regulatory role in active fatal anaphylaxis and cytokine production, thus potentially presenting tools for immune intervention. In particular, the data presented also indicated the possibility to selectively down-modulate cytokine production and NF-kB activation may offer a broad application for therapeutic intervention in neuroimmunological diseases and other pathological situations.
Subject(s)
Animals , Humans , Infant, Newborn , Mice , Anaphylaxis , Capsaicin , Cytokines , Denervation , Dermatitis, Contact , Hemagglutination , Interleukin-10 , Interleukin-12 , Interleukin-6 , Mortality , Neuropeptides , NF-kappa B , Penicillin V , Sensory Receptor Cells , Serum Albumin , Tachykinins , Whooping CoughABSTRACT
The present study was undertaken to investigate the effect of acute administration of ethanol on production of cytokines such as IL-1j3, IL-2, IL-6, IL-10 and TNF-a, induction of penicillin V-induced active fatal anaphylaxis, and resistence to Salmonel/a typhimurium infection in mice. Ethanol administration into mice was performed by intraperitoneal injection of 0.5 ml of 20 % ethanol for 3 consecutive days before induction of cytokines with lipopolysaccharide (LPS), Con A or Salmone/la injection. Serum levels of cytokines were measured by ELISA. It was found that ethanol administration significantly inhibited both the serum levels of all cytokines examined and the resistance of mice to S. typhimurium. However, ethanol administration failed to prevent penicillin-induced fatal anaphylaxis. Taken together, the present results may need new insights in the diagnosis and treatment of various immunologically-mediated diseases.
Subject(s)
Animals , Mice , Anaphylaxis , Cytokines , Diagnosis , Enzyme-Linked Immunosorbent Assay , Ethanol , Injections, Intraperitoneal , Interleukin-10 , Interleukin-2 , Interleukin-6 , Interleukins , Penicillin V , Penicillins , Salmonella Infections , SalmonellaABSTRACT
Se describió el desarrollo tecnológico de una formulación de fenoximetilpenicilina suspensión oral 125 mg para uso pediátrico, utilizando la vía seca que se inicia con la mezcla del principio activo con los sabores, estabilizadores, edulcorantes y lubricantes hasta lograr un producto estable y con las características que lo hacen adecuado para el uso que se destina. Se estudió la estabilidad del producto terminado desde el punto de vista tecnológico y químico con resultados satisfactorios. El medicamento diseñado cumple con los requisitos más actuales para su comercialización y forma parte del surtido estable de producción de la Empresa Farmacéutica "8 de marzo"
Subject(s)
Chemistry, Pharmaceutical , Drug Compounding , Drug Stability , Penicillin V , Suspensions , Technological DevelopmentABSTRACT
Neste estudo, os autores realizaram análise prospectiva do tratamento de 30 fraturas de mandíbula, onde os dentes em linhas de fraturas foram criteriosamente preservados, sob o uso profilático de antibióticos. Foram levantadas as complicaçöes que ocorreram, possivelmente relacionadas à presença dos dentes na linha de fratura e, conseqüêntemente, avaliada a conveniência em sustentá-los. Os resultados demonstraram que as complicaçöes se fizeram presente em 16,1 por cento do total de casos. Esse resultado, aliado à importância destes dentes no tratamento das fraturas, permitiu aos autores recomendarem a manutençäo criteriosa dos mesmos sempre que possível
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Anti-Bacterial Agents , Mandibular Fractures/diagnosis , Mandibular Fractures/therapy , Morbidity , Ampicillin , Dental Occlusion , Penicillin G Benzathine , Penicillin VABSTRACT
La fenoximetilpenicilina es un antibiótico ß-lactámico que tiene actividad antimicrobiana similar a la bencilpenicilina; su uso está indicado en el tratamiento de infecciones benignas o moderadamente graves. Se describe el desarrollo de la tecnología de formulación de fenoximetilpenicilina, cápsulas de 250 mg, a partir de la elaboración del granulado mediante el método de la vía seca, mezclando el principio activo con los excipientes necesarios para lograr un producto final que cumpla con las características que lo hacen adecuado para su uso. El producto obtenido fue conservado a temperatura controlada y se realizó el estudio de estabilidad, determinándose el tiempo de vida útil para esta formulación. El medicamento diseñado cumple con los requerimientos más actuales para su comercialización y posee beneficios sociales y económicos elevados
Subject(s)
Capsules , Penicillin V/standards , Chemistry, Pharmaceutical/standards , Technology, Pharmaceutical/standardsABSTRACT
En este trabajo se trata, en una forma simple y esquemática, de recordar que pequeños actos quirúrgicos, en determinados pacientes, sea en la cavidad bucal o en otras partes del organismo, son capaces de producir bacteriemia con consecuencias graves para el enfermo. Además, se señala cuáles son los principales factores de riesgo de la endocarditis bacteriana, los microorganismos más comunes causantes de lamisma, las maniobras que inducen a bacteriemias y, tomando en cuenta las últimas publicaciones, mostrar un esquema terapéutico actualizado en la prevención de la endocarditis