TOC |  ID    
Prevention of Bacterial Endocarditis 1997           See UW SBE Prophylaxis
The American Heart Association
has issued new guidelines for the prevention of bacterial endocarditis.
http://circ.ahajournals.org/cgi/content/full/96/1/358  
June 11, 1997 JAMA Vol. 277, pp 1797-1801 and the July 1, 1997 issue of Circulation.

Major changes in the updated recommendations include the following:

Key Points   REF:  ACP Online PIER  4-2003


PROPHYLACTIC REGIMENS FOR DENTAL, ORAL, RESPIRATORY TRACT, OR ESOPHAGEAL PROCEDURES
(NO FOLLOW-UP DOSE RECOMMENDED)

Regimen#

Standard general prophylaxis:

Unable to take medications:

Penicillin-allergic:

Penicillin-allergic and unable to take medications:

* Cephalosporins should not be used in individuals with immediate type hypersensitivity reaction (urticaria, angioedema, or anaphylaxis) to penicillins.


PROPHYLACTIC REGIMENS FOR GENITOURINARY/GASTROINTESTINAL
(EXCLUDING ESOPHAGEAL) PROCEDURES

High-risk patients
:   Ampicillin plus Gentamicin

Adults: ampicillin 2.0 g IM/IV plus gentamicin 1.5 mg/kg (not to exceed 120 mg) within 30 min of starting the procedure.
Six hours later, ampicillin 1 g
IM/IV or amoxicillin 1 g PO.
Children: ampicillin 50 mg/kg IM or IV (not to
exceed 2.0 gm)   plus gentamicin 1.5 mg/kg within 30 minutes of starting the procedure.
Six hours later, ampicillin 25 mg/kg IM/IV or amoxicillin 25 mg/kg PO.

High-risk patients allergic to ampicillin/amoxicillin:   Vancomycin plus Gentamicin

Adults: vancomycin 1.0 g IV over 1-2 hours plus gentamicin 1.5 mg/kg IV/IM (not to exceed 120 mg). Complete injection/infusion within 30 minutes of starting the procedure. Children: vancomycin 20 mg/kg IV over 1-2 hours plus gentamicin 1.5 mg/kg IV/IM. Complete injection/infusion within 30 minutes of starting the procedure.

Moderate-risk patients:

Adults: amoxicillin 2.0 gm PO 1 hour before procedure, OR Ampicillin 2.0 gm IM/IV within 30 minutes of starting the procedure. Children: amoxicillin 50 mg/kg PO 1 hour before procedure, OR Ampicillin 50 mg/kg IM/IV within 30 minutes of starting the procedure.

Moderate-risk patients allergic to ampicillin/amoxicillin: Vancomycin

Adults: vancomycin 1.0 gm IV over 1-2 hours. Complete infusion within 30 minutes of starting the procedure. Children: vancomycin 20 mg/kg IV over 1-2 hours. Complete infusion within 30 minutes of starting the procedure.
# Total children's dose should not exceed adult dose.

* No second dose of vancomycin or gentamicin is recommended.



Endocarditis Prophylaxis Recommended

High Risk Category

Moderate Risk Category

Endocarditis Prophylaxis Not Recommended



TABLE 2. DENTAL PROCEDURES FOR WHICH PROPHYLAXIS IS OR IS NOT RECOMMENDED

Endocarditis Prophylaxis Recommended*

Endocarditis Prophylaxis Not Recommended

* Prophylaxis is recommended for patients with high and moderate risk cardiac conditions.
^ This includes restoration of decayed teeth (filling cavities) and replacement of missing teeth
# Clinical judgment may indicate antibiotic use in selected circumstances that may create significant bleeding.

     



TABLE 3. OTHER PROCEDURES FOR WHICH PROPHYLAXIS IS OR IS NOT RECOMMENDED
Endocarditis Prophylaxis Recommended

Respiratory Tract

Gastrointestinal Tract*

Genitourinary Tract

Endocarditis Prophylaxis Not Recommended

Respiratory Tract

Gastrointestinal Tract

Genitourinary Tract

Other

* Prophylaxis is recommended for high-risk patients; optional for medium-risk patients.
# Prophylaxis is optional for high-risk patients.


     


Physicians' Recommendations to Patients for Use of Antibiotic Prophylaxis to Prevent Endocarditis
Todd B. Seto, etc.
JAMA. July 5, 2000;284:68-71  

07102000