Perioperative infective endocarditis prophylaxis
From IDWiki
Background
- Periprocedural antibiotics to prevent endocarditis are generally reserved for high-risk patients undergoing higher-risk procedures
Procedure
Patient Selection
- High risk patients include the following:
- Prosthetic cardiac valves, including transcatheter-implanted prostheses and homografts.
- Prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords.
- Previous IE.
- Unrepaired cyanotic congenital heart disease or repaired congenital heart disease, with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or prosthetic device.
- Cardiac transplant with valve regurgitation due to a structurally abnormal valve
- Moderate risk patients include patients with valvular disease (including congenital disease, rheumatic heart disease, and other valve disease), hypertrophic cardiomyopathy, and CIED implant
- Not routinely recommended but can be considered on a case-by-case basis
Procedures
- Most clearly indicated for dental procedures that involve manipulation of gingival tissue, manipulation of the periapical region of teeth, or perforation of the oral mucosa
- Includes tooth extractions, drainage of abscesses, and dental implants
- Not required for anesthetic injections in non-infected tissue, x-rays, adjustment of removable dental appliances, placement of dental brackets, shedding of primary teeth, or trauma causing bleeding to lips or oral mucosa
- Not routinely recommended for TEE, OGD, colonoscopy, or cystoscopy, though may be considered for patients undergoing invasive procedures
Antibiotic Selection
- Amoxicillin 2 g p.o. once 30 to 60 minutes before procedure
- For allergy, consider cephalexin 2 g, azithromycin 500 mg, clarithromycin 500 mg, or doxycycline 100 mg
Further Reading
- 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Circulation. 2021;143(5):e72-e227. doi: 10.1161/CIR.0000000000000923.
- 2023 ESC Guidelines for the management of endocarditis. Eur Heart J. 2023;44(39):3948-4042. doi: 10.1093/eurheartj/ehad193.