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By Grüneberg MD

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Candida endocarditis treated with 5-fluorocytosine. Brit. Med. , 1, 262 88 Darrell, J. H. (1975). Candida endocarditis. Brit. Med. , 1,432 89 Raper, A. J. and Kemp, V. E. (1965). Use of steroids in penicillin-sensitive patients with bacterial endocarditis. N. Engl. J. , 279, 1305 90 Green, G. , Peters, G. A. and Geraci, J. E. (1967). Treatment of bacterial endocarditis in patients with penicillin hypersensitivity. Ann. Intern. , 67, 235 91 Assem, E. S. K. and Vickers, M. R. (1974). Penicillin allergy tests in man.

However, for uncommon infections, such as bacterial endocarditis or infection of orthopaedic implants, it can be extremely difficult to design trials that would detect a reduction in the already low incidence of infection. For example, about 2500 obs~rvations under control conditions would be required to show a reduction in the incidence of infection from 2% to 1%, with an 80% chance of demonstrating this reduction at the 99% level of significance (or a 90% chance at the 95% level). As one surgical team is most unlikely to perform the same operation more than 200 or 300 times per year any trial of chemoprophylaxis would have to be multicentered.

M. M. M. injection 30 minutes before extraction is allergic to penicillin and has a prosthetic heart valve, intravenous vancomycin, 1 g, plus gentamicin, 80 mg intramuscularly may be given 20 minutes before the procedure and at 8 and 16 h after the procedure. Open heart surgery The organisms most likely to infect the prosthetic heart valve at the time of operation or during the immediate postoperative period include Staphylococcus aureus, Staphylococcus epidermidis and diphtheroids, although Gram-negative bacilli may also cause infection as discussed in a previous section.

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