Antibiotic prophylaxis in patients with rheumatic heart disease and prosthetic devices

Prophylaxis is defined as: "measures designed to preserve health and prevent the spread of disease" (18). Two implicit parts to such a definition are first, that what is being prevented causes disease, and second, that the measure(s) proposed prevents this disease. We will briefly review the evidence that patients with rheumatic heart disease and/or prosthetic cardiac devices are at increased risk of morbidity and mortality from infection and further that antibiotics reduce this morbidity and mortality. Antibiotic prophylaxis is undertaken in patients with rheumatic heart disease and in those with prosthetic devices for two purposes: 1. prevention of reccurrences of rheumatic fever; and, 2. prevention of infective endocarditis. These are two different issues which will be discussed separately.