Perioperative infective endocarditis prophylaxis: Difference between revisions

Latest revision as of 14:18, 27 August 2024

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

@@ Line 1: / Line 1: @@
+== Background ==
-Prophylaxis against IE is reasonable before '''dental procedures''' that involve manipulation of gingival tissue, manipulation of the periapical region of teeth, or perforation of the oral mucosa in patients with the following:
+* Periprocedural antibiotics to prevent [[Infective endocarditis|endocarditis]] are generally reserved for high-risk patients undergoing higher-risk procedures
-# '''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
+== Procedure ==
-From the [https://doi.org/10.1016/j.jacc.2017.03.011 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease].
+=== 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: [https://doi.org/10.1161/cir.0000000000000923 10.1161/CIR.0000000000000923].
+* 2023 ESC Guidelines for the management of endocarditis. ''Eur Heart J''. 2023;44(39):3948-4042. doi: [https://doi.org/10.1093/eurheartj/ehad193 10.1093/eurheartj/ehad193].
 [[Category:Perioperative medicine]]