SBE Prophylaxis
Executive Summary
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1.
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All
children with congenital heart disease should have SBE Prophylaxis (as
below), except those with secundum atrial spetal defect, post-repair
ASD/VSD/PDA with no murmur, and mitral valve prolapse without mitral
regurgitation.
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2.
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For
procedures above the diaphragm, give antibiotics one hour before the
procedure; a second dose is not necessary.
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Oral:
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Amoxicillin
(50 mg/kg; maximum = 2 grams)
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Parenteral:
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Ampicillin
(50 mg/kg IM or IV; maximum = 2 grams)
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Penicillin-Allergic:
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Clindamycin
or Cephalexin or Azithromycin, etc.
(See complete article which follows)
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Prophylaxis
is not required for flexible bronchoscopy, endotracheal intubation, or
cardiac catheterization.
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3.
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For
procedures below the diaphgragm (only IM or IV), give antibiotics
before and after the procedure:
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a)
Ampicillin: (50 mg/kg) plus Gentamicin (1.5 mg/kg) before and
Amoxicillin or Ampicillin (25 mg/kg) six hours after procedure.
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b)
For patients allergic to PCN or Ampicillin/Amoxicillin, give Vancomycin (20
mg/kg IV over 1-2 hours) plus Gentamicin (1.5 mg/kg). No second dose
is necessary.
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For
details or more information, please see complete article which follows.
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Introduction
Antibiotics are given to patients
‘at risk’ for endocarditis just before an event (eg., surgery of any kind) to
reduce the chance of infection. Though never ‘proven’, there is a body of
inferential evidence showing that such SBE (subacute bacterial endocarditis)
prophylaxis is both good care and cost-efficient. Early recommendations gave
antibiotics for two days before the procedure, but this tended to select for
resistant organisms. Current recommendation is for administration as a single
dose just before the instrumentation.
Children
"at risk"
Those pediatric cardiac conditions generally associated with danger of SBE
include:
- All cyanotic heart lesions, especially those
with systemic-to-pulmonary shunts in place.
- All post-operative coarctation patients,
whether surgically repaired or after balloon dilation, are at risk for
SBE.
- All those with valvar abnormalities, whether
congenital, rheumatic, or with prosthetic valve in place. Mitral valve
prolapse is an area of debate with many recommending NO propylaxis in the
absence of an audible murmur.
- VSD patients: the more trivial
(hemodynamically) the VSD, the higher the chance of SBE.
Patients
with ASD either pre-repair or after repair are NOT at increased risk of endocarditis.
Children after repair of VSD and PDA who have no murmur are no longer at
increased risk for endocarditis.
Procedures
generally NOT associated with endocarditis:
- Bronchoscopy with a flexible scope; when using
a rigid bronchoscope, there is commonly a bacteremia.
- Cardiac catheterization has been shown NOT to
be associated with endocarditis, despite the vascular invasion and
manipulation.
- Delivery of a baby by vaginal route is not
associated with bacteremia and therefore, SBE prophylaxis is not
necessary.
Most
up-to-date recommendations
- For dental, oral, respiratory and
esophageal procedures:
- Amoxicillin- SINGLE
DOSE - 50 mg/kg up to maximum of adult dose (2.0 grams), orally approximately
one hour before procedure. No second dose is necessary.
- For
penicillin-sensitive patients, can use clindamycin, cephalexin, or
azithromycin.
- For Genitourinary and Non-esophageal
Gastrointestinal Procedures
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Dr. Michael Dick & Dr. Todd Dillon
11123 Parkview Plaza Drive Suite 102
Fort Wayne, IN 46845
(260) 483-0688
http://www.med-web.com/nips/
nips@med-web.com |