Cardiac
cond. needing prophylaxis - cardiac valves (prosthetic,
bioprosthetic, homografts), + H/O bacterial endocarditis, surgical
pulmonary-systemic shunts, congenital cardiac malformations, rheumatic
valve dysfunction, acquired valve dysfunction, hypertrophic cardiomyopathy,
MVP with regurgitation
Cardiac cond. not needing prophylaxis -
CABG, MVP without regrugitation, physiologic or innocent heart murmurs,
cardiac pacemakers, implanted defibrillators, solitary secundum
ASD, > 6 months post repair without problems of secundum ASD
or VSD or PDA, + H/O rheumatic fever without valve dysfunction
Procedures w/prophylaxis recommended - dental
procedures leading to any bleeding, rigid bronchoscopy, esophageal
sclerotherapy, esophageal dilation, surgical procedures (T/A, GB,
GI or respiratory mucosal incisions, incision and drainage of infections),
GU procedures (cystoscopy, prostate surgery, urethral catheterization
with UTI, GU surgery with UTI, urethral dilation), OB/Gyn (vaginal
hysterectomy, vaginal delivery with other infection)
Procedures w/prophylaxis not recommended
Abx (Adult) - Standard po regimen Amoxicillin 3.0 g
po 1 hr before procedure, then 1.5 g po 6 hrs after first dose;
PCN allergic - Erythromycin ethylsuccinate 800 mg po or EM
sterarate 1.0 g po 2 hrs before procedure then 1/2 of above dose
6 hrs later, or Clindamycin 300 mg po 1 hr before procedure and
150 mg 6 hrs after first dose; Unable to take po Ampicillin
2.0 g IM or IV 30 min before procedure, then 1.0 g IV or IM or Amoxicillin
1.5 g po 6 hrs after first dose PCN allergic unable to take po
Clindamycin 300 mg IV 30 min before procedure then 150 mg IV or
po 6 hrs after first dose; High Risk - Ampicillin 2.0 g IV
or IM and Gentamycin 1.5 mg/kg (not > 80 mg) 30 min before procedure,
then Amoxicillin 1.5 g po 6 hrs after first dose or repeat IV doses
8 hrs after first dose; High Risk PCN allergic - Vancomycin
1.0 g IV 1 hr before procedure. Note - for initial pediatric dose
use Ampicillin 50 mg/kg, Amoxicillin 50 mg/kg, EM stearate or ethylsuccinate
20 mg/kg, Clindamycin 10 mg/kg, Gentamycin 2.0 mg/kg, Vancomycin
20 mg/kg. Post procedure po doses are half the initial doses. Never
exceed adult doses with pediatric doses. *Adapted from NEJM, 1/5/95,
Vol. 332 No. 1, p. 38-44
|