Antibiotic prophylaxis SDCEP

Question 1

What is infective endocarditis

Answer 1

A rare but life threatening infection of the endocardium (lining of the heart), particularly affecting the heart valves. Most cases involve those with a predisposing heart condition and is triggered by bacteria from outside the body entering the bloodstream.

Question 2

Who is at increased risk of infective endocarditits

Answer 2

• acquired valvular heart disease with stenosis/regurgitation
• hypertrophic cardiomyopathy
• previous infective endocarditis
• some with structural congenital heart disease
• valve replacement

Question 3

For the vast majority of patients with increased risk of IE, how will they be managed

Answer 3

Routine management
- without antibiotic prophylaxis

Question 4

What groups require special consideration for non-routine management

Answer 4

• patients with any prosthetic valve
• patients with previous episode of IE
• patients with a congenital heart disease

Question 5

what does routine management consist of

Answer 5

• ensure the patient is aware of their risk of IE and provide advice about prevention
• explain everyday activities e.g. toothbrushing, chewing can also cause bacteraemias and stress importance of good OH
• explain dental procedures are no longer considered the main cause of IE
• explain it is unclear whether AB prophylaxis prevents IE
• explain ABs can cause side effects +issue of resistance
• record discussion in patients clinical notes
• if they request AB prophylaxis, contact their cardiology consultant
• ensure any episodes of dental infection in patients at increased risk of infective endocarditis are investigated and treated promptly to reduce the risk of endocarditis developing

Question 6

For patients with non-routine management, what does this consist of

Answer 6

• assess the patient, consult cario team
• ensure pt aware of risks/benefits of AB prophylaxis
• prevention advice
• ensure any dental infections in this group are investigated and treated promptly

Question 7

What are invasive and non-invasive dental procedures

Answer 7

Question 8

When antibiotic prophylaxis is required, what is an appropriate regimen

Answer 8

• Amoxicillin, 3g (1 sachet) oral powder sachet, 60mins before procedure

Question 9

In patients who are allergic to penicillin, what is an appropriate oral regimen

Answer 9

Clindamycin capsules, 600mg (2 capsules), 60 mins before procedure

Question 10

What are signs and symptoms of IE

Answer 10

• high temperature
• sweats/chills
• breathlessness
• weightloss
• tiredness
• muscle, joint or back pain

Question 11

where should someone take their course of antibiotics if it is prescribed

Answer 11

60 mins before the procedure, ideally in the dental surgery