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The authors reply
2 Imperial College London, London, UK
3 Centre for Cardiovascular Medicine, University of Oxford, Oxford, UK
| The first 150 words of the full text of this article appear below. |
Our editorial1 was designed to provoke debate and alert cardiologists, many of whom were unaware, of the publication of the British Society for Antimicrobial Chemotherapy guidelines. Despite the comments made by the respondents, we believe that most will agree that endocarditis is a severe disease, that the microbiological epidemiology is not just limited to dental procedures and that there is no robust proof of the efficacy or non-efficacy of antibiotic prophylaxis.
The unwanted effects of antibiotics are often dismissed by protagonists of dental prophylaxis; however, the risk of death from penicillin anaphylaxis is 20 per million.2,3 A recent cost-effectiveness analysis showed that in a cohort of 10 million moderate- or high-risk people, penicillin would prevent 19 cases of endocarditis but cause 181 deaths due to anaphylaxis.4
We agree that clinical experience is important in determining individual patient management; however, it is not a substitute for appropriately obtained evidence from experimental
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