Infective endocarditis prevention resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamed Moubarak, M.D. [2]; Rim Halaby, M.D. [3]

Prevention

Shown below is an algorithm depicting the general prophylactic approaches of infective endocarditis.

Identify high risk patients: (Class IIa, Level of evidence B) ❑ Prosthetic valves patients ❑ Previous infective endocarditis ❑ Cardiac transplant recipients with valves regurgitation due to structurally abnormal valve ❑ Congenital heart diseases ❑ Unrepaired cyanotic congenital heart diseases ❑ Completely repaired defect with prosthetic material or device ❑ Repaired with residual defects
Identify high risk procedures: ❑ Dental procedures ❑ Manipulation of gingival tissue, or ❑ Manipulation of the periapical region of teeth, or ❑ Perforation of the oral mucosa ❑ Respiratory tract procedures involving incision of the respiratory tract mucosa ❑ Tonsillectomy ❑ Adenoidectomy ❑ Gastrointestinal (GI) and genitourinary (GU) procedures only if GI or GU tract infection is present
❑ Administer prophylaxis

Antibiotic Prophylaxis

Shown below is a table depicting the prophylaxis antibiotic regimes for infective endocarditis.

Infective Endocarditis Antibiotic Prophylaxis Oral treatment is tolerated Not allergic to penicillin Allergic to penicillin ▸ Amoxicillin 2 g ▸ Ampicillin 2 g IM or IV OR ▸ Cefazolin 1 g IM or IV OR ▸ Ceftriaxone 1 g IM or IV Oral treatment is not tolerated Not allergic to penicillin Allergic to penicillin ▸ Cefalexin 2 g OR ▸ Clindamycin 600 mg OR ▸ Azithromycin 500 mg OR ▸ Clarithromycin 500 mg ▸ Cefazolin 1 g IM or IV OR ▸ Ceftriaxone 1 g IM or IV OR ▸ Clindamycin 600 mg IM or IV

References

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