Bacterial endocarditis prophylaxis

Question 1

Which patients are at risk for bacterial endocarditis and need prophylaxis?

Answer 1

• prosthetic valves,
• history of endocarditis
• unrepaired cyanotic CHD
• repaired CHD using prosthetic material in the first 6 months after procedure
• repaired CHD with residual defects
• heart transplant with valvular dx

CHD = congenital heart defect

Question 2

what are some high risk *procedures* that may need bacterial endocarditis prophylaxis?

Answer 2

• dental manipulation of gingival tissue or periapical region of teeth, or perforation of oral mucosa
• respiratory tract procedures with incision or biopsy

-cardiac surgery

• GI/GU tract procedure with ongoing infection
• procedures or surgery with infected skin with musculoskeletal tissue

Question 3

low risk procedures do NOT need bacterial endocarditis prophylaxis

Answer 3

• GI procedures (ERCP, EGD)
• GU procedures (prostatectomy catheter insertions) as long as no ACTIVE INFECTION
• Vaginal or c section only need prophylaxis if there’s a concurrent infection going on.

Question 4

What antibiotics do we give for someone who is underlying dental/respiratory procedure and needs endocarditis prophylaxis?

Answer 4

for dental/respiratory procedure

oral: amoxicillin, cephalexin, clindamycin, or azithromycin

IV: ampicillin, ceftriaxone, clindamycin

give 30-60 minutes prior to procedure

Question 5

What type of antibiotics are given for endocarditis prophylaxis before a GI/GU procedure? (enterococcus)

Answer 5

endocarditis prophylaxis before a GI/GU procedure (b/c of concurrent infection)

amoxicillin, ampicillin, or vancomycin

Question 6

What type of antibiotics are given for endocarditis prophylaxis before a skin/MSK procedure? (staph and strep coverage)

Answer 6

skin/MSK procedure with concurrent infection prophylaxis

vancomycin, or clindamycin for suspected MRSA

Question 7

which pts need endocarditis prophylaxis for routine dental procedures such as routine cleaning and tooth extraction:

Answer 7

prior infective endocarditis pts

pts who have a high risk cardiac condition.

Question 8

in pts who have cirrhosis need bacterial endocarditis prophylaxis when they are:

Answer 8

people variceal bleeding without endoscopy percutaneous gastrostomy tube placement

when they have biliary obstruction or cholangitis and pancreatic cyst