Endocarditis antibiotic prophylaxis: Difference between revisions

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Revision as of 17:53, 17 August 2015

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.

Antibiotic Prophylaxis

Antimicrobial Regimen

1. Prophylactic Regimens for Dental Procedures^[1]^[2]^[3]

1.1 Oral regimen

Preferred regimen: Amoxicillin 2 g PO single dose (30-60 minutes before procedure)
Pediatric dose: Amoxicillin 50 mg/kg PO single dose (30-60 minutes before procedure)

1.2 Unable to take oral medication

Preferred regimen: Ampicillin 2 g IM/IV single dose (30-60 minutes before procedure) OR Cefazolin 1 g IM/IV single dose (30-60 minutes before procedure) OR Ceftriaxone 1 g IM/IV single dose (30-60 minutes before procedure)
Pediatric dose: Ampicillin 50 mg/kg; Cefazolin 50 mg/kg; Ceftriaxone 50 mg/kg

1.3 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 doses: Cephalexin 50 mg/kg single; Clindamycin 20 mg/kg; Azithromycin 15 mg/kg; Clarithromycin 15 mg/kg

1.4 Allergic to penicillins or ampicillin and unable to take oral medication

Preferred regimen: Cefazolin 1 g IM/IV single dose (30-60 minutes before procedure) OR Ceftriaxone 1 g IM/IV single dose (30-60 minutes before procedure) OR Clindamycin 600 mg IM/IV single dose (30-60 minutes before procedure)
Pediatric doses: Cefazolin 50 mg/kg; Ceftriaxone 20 mg/kg

2. Gastrointestinal/Genitourinary Procedures

Preferred regimen: Antibiotic prophylaxis to prevent IE is no longer recommended for patients who undergo a GI or GU tract procedure.
Note: High risk patients who already have an established GI or GU tract infection, it is reasonable to administer Ampicillin 2 g IM/IV single dose

3. Regimens for Respiratory Tract Procedures

3.1 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)

3.2 Unable to take oral medication

Preferred regimen: Ampicillin 2 g IM/IV single dose (30-60 minutes before procedure) OR Cefazolin 1 g IM/IV single dose (30-60 minutes before procedure) OR Ceftriaxone 1 g IM/IV single dose (30-60 minutes before procedure)

Pediatric doses: Ampicillin 50 mg/kg; Cefazolin 50 mg/kg; Ceftriaxone 50 mg/kg

3.3 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 doses: Cephalexin 50 mg/kg; Clindamycin 20 mg/kg; Azithromycin 15 mg/kg; Clarithromycin 15 mg/kg

Allergic to penicillins or ampicillin and unable to take oral medication

Preferred regimen: Cefazolin 1 g IM/IV single dose (30-60 minutes before procedure) OR Ceftriaxone 1 g IM/IV single dose (30-60 minutes before procedure) OR Clindamycin 600 mg IM/IV (30-60 minutes before procedure)
Pediatric doses: Cefazolin 50 mg/kg; Ceftriaxone 20 mg/kg

4. 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 beta-hemolytic streptococci, such as an antistaphylococcal penicillin or a cephalosporin.

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.^[4] In France, following restricted use of antibiotics the incidence of IE was stable.^[5]

References

↑ 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.
↑ Thornhill MH et al. BMJ 2011;342:d2392.
↑ Duval X, et al. J Am Coll Card 2012;59:1968-76.

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[pmid24589852-1] 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.

[pmid23474606-2] 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.

[pmid17446442-3] 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.

[4] Thornhill MH et al. BMJ 2011;342:d2392.

[5] Duval X, et al. J Am Coll Card 2012;59:1968-76.

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@@ Line 17: / Line 17: @@
 :* 1.1 '''Oral regimen'''
-::* Preferred regimen: [[Amoxicillin]] 2 g single dose 30-60 minutes before procedure.
+::* Preferred regimen: [[Amoxicillin]] 2 g PO single dose (30-60 minutes before procedure)
-::* Pediatric dose: [[Amoxicillin]] 50 mg/kg single dose 30-60 minutes before procedure.
+::* Pediatric dose: [[Amoxicillin]] 50 mg/kg PO single dose (30-60 minutes before procedure)
 :* 1.2 '''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.
+::* Preferred regimen: [[Ampicillin]] 2 g IM/IV single dose (30-60 minutes before procedure) {{or}} [[Cefazolin]] 1 g IM/IV single dose (30-60 minutes before procedure) {{or}} [[Ceftriaxone]] 1 g IM/IV single dose (30-60 minutes before procedure)
 ::* Pediatric dose: [[Ampicillin]] 50 mg/kg; [[Cefazolin]] 50 mg/kg; [[Ceftriaxone]] 50 mg/kg
 :* 1.3 '''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.
+::* 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.
+::* Pediatric doses:  [[Cephalexin]] 50 mg/kg single; [[Clindamycin]] 20 mg/kg; [[Azithromycin]] 15 mg/kg; [[Clarithromycin]] 15 mg/kg
 :* 1.4 '''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.
+::*  Preferred regimen: [[Cefazolin]] 1 g IM/IV single dose (30-60 minutes before procedure) {{or}} [[Ceftriaxone]] 1 g IM/IV single dose (30-60 minutes before procedure) {{or}} [[Clindamycin]] 600 mg IM/IV single dose (30-60 minutes before procedure)
-::* Pediatric dose: [[Cefazolin]] 50 mg/kg IM or IV {{or}} [[Ceftriaxone]] 20 mg/kg IM or IV.
+::* Pediatric doses: [[Cefazolin]] 50 mg/kg; [[Ceftriaxone]] 20 mg/kg
 * 2. '''Gastrointestinal/Genitourinary Procedures'''
-:* Preferred regimen: Antibiotic prophylaxis solely to prevent [[IE]] is no longer recommended for patients who undergo a [[GI]] or GU tract procedure.
+:* Preferred regimen: Antibiotic prophylaxis to prevent [[IE]] is no longer recommended for patients who undergo a GI or GU tract procedure.
-:: 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]].
+:* Note: High risk patients who already have an established [[GI]] or GU tract infection, it is reasonable to administer [[Ampicillin]] 2 g IM/IV single dose
 * 3. '''Regimens for Respiratory Tract Procedures'''
 :* 3.1 '''Oral regimen'''
-::* Preferred regimen: [[Amoxicillin]] 2 g single dose 30-60 minutes before procedure.
+::* 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.
+::* Pediatric dose: [[Amoxicillin]] 50 mg/kg single dose (30-60 minutes before procedure)
 :* 3.2 '''Unable to take oral medication'''
-::* Preferred regimen: [[Ampicillin]] 2 g IM/IV single dose {{or}} [[Cefazolin]] 1 g IM/IV single dose {{or}} [[Ceftriaxone]] 1 g IM/IV single dose
+::* Preferred regimen: [[Ampicillin]] 2 g IM/IV single dose (30-60 minutes before procedure) {{or}} [[Cefazolin]] 1 g IM/IV single dose (30-60 minutes before procedure) {{or}} [[Ceftriaxone]] 1 g IM/IV single dose (30-60 minutes before procedure)
-::* Pediatric dose: [[Ampicillin]] 50 mg/kg; [[Cefazolin]] 50 mg/kg; [[Ceftriaxone]] 50 mg/kg.
-:* 3.3'''Allergic to penicillins or ampicillin— Oral regimen'''
+::* Pediatric doses: [[Ampicillin]] 50 mg/kg; [[Cefazolin]] 50 mg/kg; [[Ceftriaxone]] 50 mg/kg
-::* 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.
+:* 3.3 '''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 doses:  [[Cephalexin]] 50 mg/kg; [[Clindamycin]] 20 mg/kg; [[Azithromycin]] 15 mg/kg; [[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]].
+::*  Preferred regimen: [[Cefazolin]] 1 g IM/IV single dose (30-60 minutes before procedure) {{or}} [[Ceftriaxone]] 1 g IM/IV single dose (30-60 minutes before procedure) {{or}} [[Clindamycin]] 600 mg IM/IV (30-60 minutes before procedure)
-::* Pediatric dose: [[Cefazolin]] 50 mg/kg [[IM]] or [[IV]] {{or}} [[Ceftriaxone]] 20 mg/kg [[IM]] or [[IV]].
+::* Pediatric doses: [[Cefazolin]] 50 mg/kg; [[Ceftriaxone]] 20 mg/kg
 * 4. '''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]].
+:* 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 beta-hemolytic [[streptococci]], such as an antistaphylococcal [[penicillin]] or a [[cephalosporin]].
 ==Impact of Restricting Prophylactic Antibiotics==