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BACTERIAL ENDOCARDITIS (BE) PROPHYLAXIS

Description

Bacterial endocarditis is a life-threatening inflammation of the endocardium and valves caused by a bacterial infection. Certain lesions predispose to this infection, and antibiotic prophylaxis is recommended for some types of dental procedures or surgery. The evidence for this practice is sparse.

Patients predisposed to BE for whom prophylaxis is recommended1

  1. History of BE.

  2. Prosthetic heart valve.

  3. Prosthetic material used for heart valve repair.

  4. Congenital heart disease (CHD) involving unrepaired cyanotic heart defects, including shunts and conduits.

  5. CHD with defects completely repaired with prosthetic material or device for the first six months post repair. After this time, the prosthetic material should be endothelialised.

  6. CHD with repaired defects but with residual defects at, or adjacent to, the site of the prosthetic patch or device. The residual defect can inhibit endothelialisation.

  7. Rheumatic heart disease in indigenous Australians or others at significant socio-economic risk.

  8. Heart transplant patients (consult patient's cardiologist for specific recommendations). The usual indication is a structurally abnormal valve.

Procedures that require BE prophylaxis

Dental

  1. Extractions.

  2. Replanting avulsed teeth.

  3. Periodontal procedures, including subgingival scaling and root planing.

  4. Other invasive dental procedures.

Respiratory

  1. Any procedure requiring incision into the respiratory mucosa, including tonsils, adenoids, bronchial, sinus, nasal or middle ear mucosa.

  2. Nasotracheal intubation.

Genitourinary

  1. Any procedure for which antibiotic prophylaxis is indicated for surgical reasons e.g. lithotripsy.

  2. Any procedure where there is pre-existing infection unless the patient is already being treated with antibiotics targeting the infecting organism.

Gastrointestinal

  1. Sclerotherapy for oesophageal varices.

  2. Any procedure in the presence of intra-abdominal infection unless the patient is already being treated with antibiotics targeting the infecting organism.

  3. Percutaneous endoscopic gastrostomy.

Other

  1. Incision and drainage of abscesses (brain, epidural, lung, orbit, liver and other sites).

  2. Surgery involving cutting through infected skin.

Antibiotics for BE prophylaxis1

  1. Dental procedures—amoxicillin 2 g PO 1 h before procedure. If penicillin allergic, clindamycin 600 mg PO 1 h before procedure.

  2. All other procedures—amoxicillin 2 g IV 30–60 min prior to procedure. If penicillin allergic, clindamycin 600 mg IV 30–60 min prior to the procedure or vancomycin 1 g IV over 1 h, started 30 min to 2 h before procedure. Give clindamycin over 20 min. Give vancomycin 1.5 g over 90 min if patient > 80 kg.

Children's dosages are amoxicillin 50 mg/kg up to 2 g, clindamycin 20 mg/kg up to 600 mg, vancomycin 30 mg/kg.

BALLANTYNE SYNDROME

BARIATRIC SURGERY

Introduction

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