So, when we have to use antibiotic prophylaxis, we should use it. So, when do we recommend
that you use antibiotics to prevent endocarditis? Well, anytime we’re going to do have manipulation
of the gingivae, like major dental surgery, drainage of an abscess, or the periapical regions of the teeth.
Any kind of major surgery involving perforation of the oral mucosa, say extensive ENT type surgery
in patients who are at risk for endocarditis. These patients would be those who have a prosthetic
heart valve. It’d be horrible to get one of those infected. So, we err on the side of over treating them.
Someone who has had previous infective endocarditis is likewise predisposed to get it again.
So, we would definitely give them antibiotic prophylaxis as we would patients with congenital heart disease.
And because of the consequences of missing it, somebody who’s had a heart transplant or who has
some kind of valvulopathy, we certainly would err on the side of over-prophylaxing them.
What we use generally is amoxicillin in oral form, 2g. That’s usually just one dose about 30 minutes
prior to the procedure. If they’re unable to take by mouth then we’re forced to give them ampicillin
either by vein or intramuscularly but they still need it. If they’re penicillin allergic, we recommend cephalexin,
clindamycin for the oral regimen. If they can’t take that, it would be IV cefazolin or ceftriaxone
or IV clindamycin. All of this is in a single dose. Other procedures that require antibiotic prophylaxis
include major kind of invasive procedures in the respiratory tract, incisional biopsy of the respiratory tract
mucosa, taking out the tonsils or adenoids. It’s really the same as for dental procedures.
Procedures that treat established infection, for example, drainage of an abscess. I should remind you
that here, we give more than one dose because we’re treating a disease. We’re treating an abscess.
So, we would complete the therapy for such a problem because this is treatment, not prophylaxis.
Other procedures requiring antibiotic prophylaxis would be musculoskeletal surgery, a procedure to treat
some established infection in the muscles or cellulitis in the skin, or septic arthritis or osteomyelitis.
Once again, these are conditions that we would complete treatment on, not a single dose.
We would base our treatment, not really prophylaxis, our treatment on the basis of the organism
causing the problem. The other thing is GI or GU procedures. We used to recommend treating
or giving prophylaxis to anybody getting one of these. But actually, those guidelines that I mentioned
no longer recommend antibiotics for GI or GU tract procedures with one caveat. That would be
that if somebody has a urinary tract infection and they have to undergo some kind of invasive procedure
emergently, you would go ahead and treat. But it’s treating an active infection rather than prophylaxis.