II. Background: Rationale regarding Guideline changes from 1997 to 2007

  1. Endocarditis is far more frequent randomly than during dental and other procedures
  2. Prophylaxis prevents few endocarditis cases
  3. Risk of adverse events from antibiotics outweighs benefit of endocarditis prevention
  4. Optimal Oral Hygiene is key in endocarditis prevention
    1. Much more important than SBE antibiotic prophylaxis

III. Indications: Prophylaxis recommended

  1. Prosthetic Cardiac Valves (biograft and homograft) or prosthetic materials to repair valves
  2. Previous Bacterial Endocarditis with or without heart disease
  3. Specific congenital cardiac malformations
    1. Unrepaired Cyanotic Congenital Heart Disease
    2. Completely repaired Congenital Heart Disease with prosthetic material in first 6 months
    3. Partially repaired Congenital Heart Disease with residual defect
  4. Cardiac Transplantation recipients with cardiac valvulopathy

IV. Indications: Prophylaxis NOT recommended (significant change from prior guidelines)

  1. Rheumatic and other acquired valve dysfunction
  2. Hypertrophic Cardiomyopathy
  3. Mitral Valve Prolapse with valvular regurgitation
  4. Isolated secundum Atrial Septal Defect (ASD)
  5. Surgical repair of secundum ASD, VSD, or PDA
    1. Without residual defect beyond 6 month post-operative period
  6. Previous Coronary Artery Bypass (CABG)
  7. Mitral Valve Prolapse without valvular regurgitation
  8. Physiologic, functional, or innocent Heart Murmurs
  9. Previous Kawasaki Disease without valve dysfunction
  10. Cardiac Pacemakers and implanted Defibrillators

V. Indications: Procedures warranting prophylaxis

  1. Invasive respiratory procedures (e.g. bronchoscopy)
  2. Dental Procedures
    1. Gingival or periapical region of teeth manipulated or
    2. Oral Mucosa perforated
  3. SBE Prophylaxis NOT indicated in other procedures
    1. Gastrointestinal and genitourinary procedures do not require SBE Prophylaxis
    2. Perioperative antibiotic prophylaxis may be indicated for reasons outside of SBE Prophylaxis

VI. Protocol: General

  1. Oral prophylaxis given 1 hour before procedure
  2. IV prophylaxis given 30 minutes before procedure
  3. Dose after procedure not recommended in 2007 guidelines

VII. Protocol: Adult Prophylaxis: Dental, Oral, Respiratory, Esophageal

  1. Standard Regimen
    1. Amoxicillin 2g orally 1 hour before procedure or
    2. Ampicillin 2g IM/IV 30 minutes before procedure
  2. Penicillin Allergic
    1. Clindamycin
      1. 600 mg orally 1 hour before procedure or
      2. 600 mg IV 30 minutes before
    2. Cephalexin OR Cefadroxil 2g PO 1 hour before
    3. Cefazolin or Ceftriaxone 1.0g IM/IV 30 min before procedure
    4. Azithromycin or Clarithromycin 500mg PO 1h before

VIII. Protocol: Child Prophylaxis: Dental, Oral, Respiratory, Esophageal

  1. Standard Regimen
    1. Amoxicillin 50 mg/kg (MAX 2g) 1h before procedure
    2. Ampicillin 50 mg/kg (MAX 2g) IM/IV 30m before
  2. Penicillin Allergic
    1. Clindamycin
      1. Oral: 20 mg/kg PO 1h (MAX 600mg) before or
      2. IV: 20 mg/kg (MAX 600mg) IV 30m before
    2. Cephalexin 50 mg/kg (MAX 2g) PO 1h before or
    3. Cefadroxil 50 mg/kg (MAX 2g) PO 1h before or
    4. Cefazolin or Ceftriaxone 50 mg/kg (MAX 1g) IM/IV 30m before
    5. Azithromycin 15 mg/kg (MAX 500mg) PO 1h before or
    6. Clarithromycin 15 mg/kg (MAX 500mg) PO

IX. Protocol: Gastrointestinal or Genitourinary prophylaxis

  1. No longer recommended (see above)
  2. Prior guidelines (1997)
    1. High risk patients were given Ampicillin and Gentamicin before and Ampicillin after procedure
    2. Moderate risk patients were given Ampicillin before and after procedure
    3. Penicillin allergic patients were given Vancomycin in place of Ampicillin

X. Reference

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