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 News about Infect. Endocarditis proph.  



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Author35 Posts
  #1

New Guidelines for prevention of infective endocarditis (2007) - since we have to be up to date:

PROPHYLAXIS RECOMMENDED:

prostetic cardiac valve; previous IE; congenital heart disease: unrepaired CHD, first six months post-op, repaired with residual defects; cardiac transplantation recipients who develop cardiac valvulopathy

PROCEDURES:

all dental involving manipulation of gingival tissue or periapical region of teeth or perforation of the oral mucosa

NO PROPHYLAXIS for gastrointestinal or genitourinary procedures

ANTIBIOTICS: amoxicillin PO or ampicillin IM/IV or cefazolin IM/IV or ceftriaxone IM/IV or clindamycin or azithromycin/clarithromycin (last two in case of penicillin alergy)


Edited by arlete on Feb 17, 2009 - 5:14 AM



  #2

Thanks Arlete!



  #3

"NO PROPHYLAXIS for gastrointestinal or genitourinary procedures "
I dont get it. So they ignore STREP FEACALIS or GRAM NEGATIVE BACTERIA even in high risk patients?


  #4

This is how I understand that. You need to meet both requirements in order to get prophylaxis: underlying heart disease and procedure that can cause bacteremia. GI and GU procedures alone would not lead to endocarditis.


  #5

Even if you have underlying heart disease, prophylaxis is no longer done for GI and GU procedures.

Link:

cardiology.jwatch.org/cgi/c...gi/content/full/2007/530/1



  #6

It's a matter of cost/benefit. Apparently, the risk of antibiotic use is greater than acquiring IE in these procedures. We are exposed to bacteremia every time we chew, brush our teeth, floss, etc. So the indications were reviewed and simplified.



  #7

Thanks arlete!


  #8

thanks arlete...thts an important piece of information!!



  #9

I thought so. But I am a cardiologist and lost an uncle to IE, so I am very biased.

You're welcome.





  #10

thanks Arlete!!! very hellpful!! smiling face


  #11





  #12

Thanks alot Arlete, that was very helpful nod
Have a question please:
Do u give proph AB for a dental procedure to a pt with Asymptomatic AR due to childhood Rhematic Fever?
I believe No, But Kaplan says YES! i don't know why? shaking head
What do u think?
Thanks alot smiling face


  #13

hey there is also one more point with regard to the IE prophylaxis in a case of a pt. with mitral valve prolapse who is asymptomatic and on examination has no murmur heard the valve click is heard. So in such pt. who is undergoing the dental procedure, we do not give the infective endo. prophylaxis as it will not effect the outcome of the patient.
The lack of a murmur indicates that blood is not being regurgitated into the atrium. In this setting, the patient does not require antibiotics for endocarditis prophylaxis prior to the dental procedure. Prophylaxis for patients with MVP is recommended if a murmur is present or if evidence of nontrivial mitral regurgitation is found on the echocardiogram.


  #14

We do NOT give it anymore, for none of the situations mentioned by you two. If Kaplan says something different, it's outdated. disapproval
Please, read the link given above.
Thanks for the compliments, drms, you always brighten my day! wink


  #15

Thanks a Million Arlete smiling face
Wish u all the best smiling face


  #16

Same here. wink


  #17

Thanks a ton.... n Happy new year!


  #18

To you too! wink


  #19

What about Vag. delivery & CS, do we give proph AB? rolling eyes


  #20

thanks for the post it just seems strange at first. i checked it on AHA association it seems correct lol
www.americanheart.org/prese...nter.jhtml?identifier=4436

well for the exam definitely we will follow these guidlines

do you really think american doctors will follow it in real life and if a patient get IE immediatly after GU or GI procedure the doctor will probably get sued for an antibiotic with couple of dollars shaking head





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