Prophylaxis

Question 1

Pts at highest risk for endocarditis

Answer 1

Prosthetic heart valves, including bioprosthetic and homograft valves.
Prosthetic material used for cardiac valve repair.
A prior hx of IE.
Unprepared cyanotic CHD, including palliative shunts and conduits.
Completely repaired CHD with prosthetic material or device, whether placed by surgery or by catheter intervention, during first 6 months after procedure.
Repaired CHD with residual defects at the site or adjacent to the site of the prosthetic device.
Cardiac valvulopathy in a transplanted heart.

Question 2

Highest risk procedures that should require abs prophylaxis

Answer 2

Dental procedures that involve manipulation of either gingival tissue or periapical region of teeth or perforation of the oral mucosa
Procedures of the rest tract that involve incision or biopsy of rest mucosa
GI or GU procedures in pts with ongoing GI/GU tract infection
Procedures on infected skin, skin structure, or MSK tissue
Surgery to place prosthetic heart valves or prosthetic intravascular or intracardiac materials

Question 3

Preferred regimen for endocarditis ppx in dental procedure

Answer 3

Oral amox 2 g given 30-60 minutes before the procedure

Question 4

Preferred abx for pts with ongoing GI/GU tract infection and high risk cardiac condition

Answer 4

Abs with activity against enterococci (amok or ampicillin); vance is 2nd line.