Endocarditis Prophylaxis - A Quick Review

Endocarditis Prophylaxis
The only cardiac defects that need prophylaxis are the following:
·· Prosthetic valves
·· Unrepaired cyanotic heart disease
·· Previous endocarditis
·· Transplant recipients who develop valve disease

The only procedures that need prophylaxis are the following:
·· Dental procedures that cause bleeding: The prophylactic antibiotic to use for dental procedures is amoxicillin. For penicillin-allergic patients, clindamycin is the drug of choice.
·· Respiratory tract surgery
·· Surgery of infected skin

The following procedures do not need prophylaxis:
·· Dental fillings
·· All flexible scopes
·· All OB/GYN procedures
·· All urinary procedures, including cystoscopy

The following cardiac defects do not need prophylaxis:
·· Aortic stenosis or regurgitation
·· Mitral stenosis or regurgitation
·· Atrial or ventricular septal defects
·· Pacemakers and implantable defibrillators
·· Mitral valve prolapse, even if there is a murmur
·· HOCM (IHSS)



What is the drug to give as prophylaxis?
·· Dental/oral procedures:
-- Amoxicillin
-- If rash to penicillin: Cephalexin
-- If anaphylaxis to penicillin: Azithromycin, clarithromycin, or clindamycin

·· Skin procedures:
-- Cephalexin
-- If allergic to penicillin: Vancomycin