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]

Overview

Prevention of infective endocarditis can be achieved through the administration of antiobiotic prophylaxis to high risk subjects who are undergoing high risk procedures. The choice of antibiotic prophylaxis depends on whether the subject can tolerate oral intake or not, as well as on whether patient has allergy to penicillin or not.

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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