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GUIDELINES FOR ANTIBIOTIC PROPHYLAXIS
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Persons with certain heart conditions must take antibiotics to prevent bacterial endocarditis, which is a potentially fatal infection. It causes inflammation of the heart's valve, or its inner lining which can ultimately deform the heart, and irreversibly damage it. Bacterial endocarditis can occur from invasive procedures, such as dental surgery where bacteria from the mouth enters the blood stream. If proper antibiotics are given prior to invasive events, the bacteria will be killed before they can gain a foothold on damaged valves. |
| The new guidelines for
antibiotic prophylaxis have been simplified. The standard
regimen for a person at risk of endocarditis is now a single dose of
amoxicillin at a dose of 2 gram before the medical procedure. There
is no need for a follow up dose. For penicillin-allergic patients,
clarithromycin derivatives are now the second option. The
report also focuses in on the medical conditions thought to require
antibiotic therapy before invasive procedures. Patients with
mitral valve prolapse only need to take an antibiotic if they have a
floppy, myxomatous (thickened) valve or if they have a detectable mitral
regurgitation murmur.
source: American Heart Association, June 10, 1997; The Journal of the American Medical Association. You may also wish to see the page entitled "infective endocarditis bacteria watch" for procedures not covered by the American Heart Association which in some knowledgeable peoples opinion, antibiotics should be considered and used. |
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those at risk, requiring antibiotics, prosthetic heart valves, previous bacterial endocarditis, complex cyanotic heart disease (eg. single ventricle, transposition, tetralogy of Fallot), surgically constructed systemic pulmonary shunts, most congenital conditions not listed elsewhere, acquired valvular dysfunction, hypertophic cardiomyopathy, mitral valve prolapse with regurgitation and/or thickened leaflets. those generally not requiring antibiotics, atrial septal defect-isolated secundum, surgical repair of ASD, VSD, PDA, coronary bypass surgery, mitral valve prolapse without regurgitation, functional heart murmur, Kawasaki disease without valvular regurgitation, previous rheumatic fever without valvular dysfunction, pacemakers and implanted defibrillator. |
| DENTAL: | required: dental extractions, other periodontal procedures including surgery, scaling, root planing, probing, recall maintenance, dental implants, and re-implantation of teeth., endodontic (root canal), not required: local anesthetic injection, placement of rubber dams, suture removal, taking of oral impressions, fluoride treatment, orthodontic appliance adjustment. |
| OTHER SURGICAL: | required: surgical
procedures that involve the mouth and oral cavity, upper respiratory tract
and the gastrointestinal and genitouinary system, some of
these procedures include tonsillectomy, adenoidectomy, billary tract
surgery, as will as other operations that involve the intestinal
mucosa. not required: vaginal
hysterectomy, vaginal delivery, cesarean
section, cardiac catheterization, balloon
angioplasty, implanted pacemakers or
defibrillators, coronary stents.
Note: patients at high risk may choose antibiotics for vaginal hysterectomy or vaginal delivery. |