Endocarditis antibiotic prophylaxis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Michael W. Tempelhof, M.D.
Overview
Administration of antiobiotic prophylaxis is only recommended to high-risk patients undergoing specific procedures. Generally, Amoxicillin 30-60 minutes prior to the procedure is preferred for prophylaxis against endocarditis.
Impact of Restricting Prophylactic Antibiotics
There is data showing that the institution of these more restrictive guidelines does not increase the risk of endocarditis. The NICE guidelines recommended no antibiotic prophylaxis for any patient, and despite a 78.6% reduction in the administration of IE prophylaxis, there was no documentation of an increase in IE cases due to streptococci.[1] In France, following restricted use of antibiotics the incidence of IE was stable.[2]
Antimicrobial Regimen
- Oral regimen
- Preferred regimen: Amoxicillin 2 g single dose 30-60 minutes before procedure.
- Pediatric dose: Amoxicillin 50 mg/kg single dose 30-60 minutes before procedure.
- Unable to take oral medication
- Preferred regimen: Ampicillin 2 g IM or IV single dose 30-60 minutes before procedure OR Cefazolin 1 g IM or IV single dose 30-60 minutes before procedure OR Ceftriaxone 1 g IM or IV single dose 30-60 minutes before procedure.
- Pediatric dose: Ampicillin 50 mg/kg; Cefazolin 50 mg/kg; Ceftriaxone 50 mg/kg
- Allergic to penicillins or ampicillin— Oral regimen
- Preferred regimen: Cephalexin 2 g single dose 30-60 minutes before procedure OR Clindamycin 600 mg single dose 30-60 minutes before procedure OR Azithromycin 500 mg single dose 30-60 minutes before procedure OR Clarithromycin 500 mg single dose 30-60 minutes before procedure.
- Pediatric dose: Cephalexin 50 mg/kg single; Clindamycin 20 mg/kg; Azithromycin 15 mg/kg OR Clarithromycin 15 mg/kg.
- Allergic to penicillins or ampicillin and unable to take oral medication
- Preferred regimen: Cefazolin 1 g IM or IV single dose 30-60 minutes before procedure OR Ceftriaxone 1 g IM or IV single dose 30-60 minutes before procedure OR Clindamycin 600 mg IM or IV.
- Pediatric dose: Cefazolin 50 mg/kg IM or IV OR Ceftriaxone 20 mg/kg IM or IV.
- Gastrointestinal/Genitourinary Procedures
- Note: Routine administration of prophylactic antibiotics prior to GI and GU procedures including diagnostic esophagogastroduodenoscopy or colonoscopy is not recommended. However, for the high risk patients who already have an established GI or GU tract infection, it is reasonable to administer antibiotics against enterococci which includes the following: Ampicillin 2 g IM or IV single dose, piperacillin, or vancomycin.
- Regimens for Respiratory Tract Procedures
- Oral regimen
- Preferred regimen: Amoxicillin 2 g single dose 30-60 minutes before procedure.
- Pediatric dose: Amoxicillin 50 mg/kg single dose 30-60 minutes before procedure.
- Unable to take oral medication
- Preferred regimen: Ampicillin 2 g IM or IV OR Cefazolin 1 g IM or IV OR Ceftriaxone 1 g IM or IV.
- Pediatric dose: Ampicillin 50 mg/kg; Cefazolin 50 mg/kg; Ceftriaxone 50 mg/kg.
- Allergic to penicillins or ampicillin— Oral regimen
- Preferred regimen: Cephalexin 2 g single dose 30-60 minutes before procedure OR Clindamycin 600 mg single dose 30-60 minutes before procedure OR Azithromycin 500 mg single dose 30-60 minutes before procedure OR Clarithromycin 500 mg single dose 30-60 minutes before procedure.
- Pediatric dose: Cephalexin 50 mg/kg single; Clindamycin 20 mg/kg; Azithromycin or Clarithromycin 15 mg/kg.
- Allergic to penicillins or ampicillin and unable to take oral medication
- Preferred regimen: Cefazolin 1 g OR ceftriaxone 1 g IM or IV single dose 30-60 minutes before procedure OR Clindamycin 600 mg IM or IV.
- Pediatric dose: Cefazolin 50 mg/kg IM or IV OR Ceftriaxone 20 mg/kg IM or IV.
- Regimens for Procedures on Infected Skin, Skin Structure, or Musculoskeletal Tissue
- Patients who undergo a surgical procedure that involves infected skin, skin structure, or musculoskeletal tissue, it may be reasonable that the therapeutic regimen administered for treatment of the infection contain an agent active against staphylococci and -hemolytic streptococci, such as an antistaphylococcal penicillin or a cephalosporin.
References
- ↑ Thornhill MH et al. BMJ 2011;342:d2392.
- ↑ Duval X, et al. J Am Coll Card 2012;59:1968-76.
- ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. 129 (23): 2440–92. doi:10.1161/CIR.0000000000000029. PMID 24589852.
- ↑ Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H; et al. (2013). "[Guidelines on the management of valvular heart disease (version 2012). The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)]". G Ital Cardiol (Rome). 14 (3): 167–214. doi:10.1714/1234.13659. PMID 23474606.
- ↑ Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M; et al. (2007). "Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group". Circulation. 116 (15): 1736–54. doi:10.1161/CIRCULATIONAHA.106.183095. PMID 17446442.