Subacute Bacterial Endocarditis (SBE) prophylaxis

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Follow the AHA 2007 guidelines for antibiotic prophylaxis for high-risk patients undergoing high-risk procedures [1]:

Note: there is a lack of evidence that antibiotic prophylaxis provides any benefit, but currently there isn’t enough evidence to justify a change in practice [2].

Prosthetic joints: no antibiotic prophylaxis for patients with prosthetic joint undergoing dental procedures, or gastrointestinal or genitourinary procedures (Canadian Dental Association Position Statement, 2013).

High-risk patients:

  • Patients with prosthetic heart valves (mechanical or tissue), or prosthetic material used for cardiac valve repair
  • Patients with a prior history of infective endocarditis
  • Cardiac transplant patients with leaflet pathology/regurgitation
  • Some patients with congenital heart disease, including unrepaired cyanotic, repaired with prosthetic material within 6 months, and repaired with residual defects at the site of the prosthetic device

High-risk procedures:

  • Dental: manipulation of gingival tissue or oral mucosa (NOT routine cleaning, anaesthetic injection through tissue, or placement of orthodontic appliances)
  • Respiratory: incision/biopsy of respiratory tract mucosa (e.g. tonsillectomy, bronchoscopy with biopsy)
  • Genitourinary: no prophylaxis (unless working in area of active infection)
  • Gastrointestinal: no prophylaxis (unless working in area of active infection)
  • Skin and musculoskeletal: no prophylaxis (unless working in area of active infection)

Rx, single dose (choose 1):

  • Amoxicillin 2 g
  • Cephalexin 2 g
  • Azithromycin 500 mg
  • Clindamycin 600 mg).

References

  1. Wilson W. et al. Prevention of infective endocarditis: 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. 2007; 116:1736-54.
  2. Glenny A.M., Oliver R., Roberts G.J., Hooper L., Worthington H.V. Antibiotics for the prophylaxis of bacterial endocarditis in dentistry. Cochrane Database of Systematic Reviews. 2013; Issue 10. Art. No.: CD003813.