Prevention of endocarditis in the Nordic countries.

Bacterial endocarditis as the consequence of an iatrogenic bacteraemia has been recognized for a long time in the Nordic countries, and national recommendations were issued by groups of experts. It is generally agreed that antibiotic prophylaxis is needed in patients with high-risk conditions and that the maintenance of healthy gums and teeth is of major importance. Investigations, however, reported poor level of compliance, and pointed out that the procedural/practical aspect of interactions between patients, dentists and physicians have largely been neglected. In order to improve the level of compliance an 'endocarditis risk' card has been produced, and there has been a remarkable degree of harmonization of chemotherapeutic regimens recommended by the national organizations. Generally, a single dose of prophylaxis is recommended, because there is little evidence that antibiotic levels in humans must be maintained more than 6-7 h for effective prevention of endocarditis, and because compliance with a multiple dose regimen is highly questionable.