Endocarditis prophylaxis

High risk conditions

1. Prosthetic valve

2. Prior endocarditis

3. Pulmonary systemic shunt surgery

4. Poor development of heart – cyanotic

5. Prolapse mitral valve with regurgitation

 

Prophylaxis is recommended for some procedures : If you look at all these procedures, they have one thing in common – potential to stir up a lot of bacteria upon performing the procedure.

Dental :

Cleaning of teeth or implants if bleeding expected (heavy scale or gingivitis present),

Tooth extraction, periodontal procedures,

Root canal, sub gingival surgery, implant

Respiratory procedures:

Rigid bronchoscopy, bronchial biopsy, T&A

GI:

Surgery on or through intestinal mucosa – like endoscopic biopsy. ERCP in biliary obstruction, Variceal sclerotherapy, esophageal dilatation (MEVD)

GU:

Cystoscopy, Prostate surgery, urethral dilatation. Note that it is not needed for a foley catheter insertion.

 

Medication recommended can be given PO – 1 hr prior or IV/IM 30 min prior.

Amoxil 2 gm PO 1 hr prior to procedure. If needed IV, use Ampicillin same dose IV/IM 30 min before.

If allergic to PCN – Clindamycin, 600 mg PO 1 hr before or same dose IV 30 min before.

True False questions

  1. PO drugs are given 30 min before procedure

  2. IV drugs are given 15 min before procedure

  3. Mitral valve with or without regurgitation requires prophylaxis

  4. Cutting through gums requires prophylaxis.

  5. IV Amoxicillin dose is half that of PO

ANSWERS

All are false except  4

PO drugs 1 hour before, IV 30 min before. MVP without regurgitation is not an indication for prohylaxis & IV doses for both CLinda and Amoxil are exactly the same as PO doses. How I remember is that Clinda comes in 150 mg tablet and Amoxicicillin in 500 mg capsules. 4 of  either one is the proper dose.