Cardiovascular medicine: PDF OnlyFreed Michael D. MDCurrent Opinion in Pediatrics: October 1992 - p 821-827 Buy Abstract Bacterial endocarditis remains one of the most problematic complications of heart disease in children. With changes in the patient population over the past decades, the substrate for the disease has shifted from the patient with rheumatic heart disease or unoperated congenital heart disease to the postoperative patient with congenital heart disease and those with mitral valve prolapse. The infecting organisms are less commonly Streptococcus and more frequently Candida and gram-negative organisms. Mortality continues to fall. It now approaches 10% overall and 5% for those with nonfungal endocarditis. Although transthoracic and transesophageal echocardiography has become a valuable tool in the diagnosis of adults with acquired heart disease, its role in children with congenital heart disease remains to be determined. Changes have been suggested for the antimicrobial prophylaxis of endocarditis by a committee of the American Heart Association. Oral amoxicillin has replaced penicillin for routine dental work, and clindamycin has been added to erythromycin as an alternative for those unable to take the standard regiment. Oral agents have been found acceptable even for those at high risk, predominantly children with prosthetic valves. Two recent case-control studies in adults have shown the limitation of antimicrobial prophylaxis to prevent endocarditis, with estimates that fewer than 10% of cases might be prevented using current techniques. © Lippincott-Raven Publishers.