ABSOLUTE indications of prophylaxy in IE - danesh

[ArchivalUser]

1-previous IE(is it most imp??)
2-prosthetic heart valves
3-most congenital cyanotic H.dx..IF NOT REPAIRED
4-dental procetures
5-tonsillectomy & adenoidectomy

THAT'S IT????? any comment???

[ArchivalUser]

not tonsillectomy & adenoidectomy

[ArchivalUser]

don't know whether 1st is most imp or not.if somebody knows please comment.

cardiac valvuloplasty in a transplanted heart is also an indication

[ArchivalUser]

thanks for reply
tonsillectomy &/or adenoidectomy include this(kaplan2008-2009)

[ArchivalUser]

ok

[ArchivalUser]

How about non cyanotics H. dx...
6-(((aortic valve dx & mitral regurgitation (those are not due to rheumatic or other acquired valvular dx), so just congenital causes (including Marfan) aortic valve dx and mitral regurgitation, VSD,(Not ASD), PDA, Coarctation of aorta)))...... if not repaired.
7-indwelling Rt. heart catheters

that's very imp topic.....correct me if i'm wrong???

[ArchivalUser]

Danesh
nonono
those not included

shud look this up
http://circ.ahajournals.org/cgi/reprint/...106.183095

Table 6 has the summary

[ArchivalUser]

thank u so much Hopeofglory,
we modify the absolute...... as below

I--dental procetures(that involve manipulation of gingival tissues or periapical region of teeth or perforation of oral mucosa only for patients with underlying cardiac conditions associated
with the highest risk of adverse outcome from IE):
....((1-previous IE
......2-prosthetic heart valves
......3-Congenital heart disease (CHD)*
--------->Unrepaired cyanotic CHD, including palliative shunts and conduits
--------->Completely repaired congenital heart defect with prosthetic material or
---------------device, whether placed by surgery or by catheter intervention, during the
---------------first 6 months after the procedure 
--------->Repaired CHD with residual defects at the site or adjacent to the site of a
....................prosthetic patch or prosthetic device (which inhibit endothelialization)
......4-tonsillectomy & adenoidectomy
......5-Cardiac transplantation recipients who develop cardiac valvulopathy.....))

II--for procedures on respiratory tract or infected skin, skin structures, or musculoskeletal tissue only for patients with underlying cardiac conditions associated with the highest risk of
adverse outcome from IE

[ArchivalUser]

thanks Danesh, this is new and a mess in uw and kaplan, that is the best u wrote, we discuss it before, i cudnt find the link:

Antibiotic prophylaxis is no longer recommended for any other form of CHD,
except for congenital CHD
Antibiotic prophylaxis is recommended for all dental procedures that involve
manipulation of gingival tissues or periapical region of teeth or perforation of
oral mucosa only for patients with underlying cardiac conditions associated
with the highest risk of adverse outcome from IE (Table 3).
Antibiotic prophylaxis is recommended for procedures on respiratory tract or
infected skin, skin structures, or musculoskeletal tissue only for patients
with underlying cardiac conditions associated with the highest risk of
adverse outcome from IE (Table 3).
Antibiotic prophylaxis solely to prevent IE is not recommended for GU or GI
tract procedures.
The writing group reaffirms the procedures noted in the 1997 prophylaxis
guidelines for which endocarditis prophylaxis is not recommended and
extends this to other common procedures, including ear and body piercing,
tattooing, and vaginal delivery and hysterectomy.

[ArchivalUser]

Antibiotic prophylaxis is recommended for prosthetic heart valves, patients
with a history of infective endocarditis, those with cyanotic heart disease
(unrepaired or within six months after repair), or heart transplant recipients
with valvulopathy. (AHA 2007 guidelines no longer recommend it
for hypertrophic cardiomyopathy, valvular disease, and mitral valve prolapse
with a murmur or thickened leaflet.)
â–  Procedures for which prophylaxis is recommended include dental extractions
and periodontal procedures; incision or biopsy of respiratory mucosa
(e.g., tonsillectomy, transbronchial biopsy); and procedures on infected
skin or musculoskeletal structures (e.g., abscess drainage).
Prophylaxis may also be reasonable for patients with enterococcal UTIs
who will have invasive urinary procedures. (AHA 2007 guidelines no
longer recommend prophylaxis for GI or GU procedures.)
â–  For dental procedures: PO amoxicillin, IV ampicillin, or IV/PO clindamycin
30“60 minutes before the procedure.
â–  For procedures on infected skin or musculoskeletal structures: PO
cephalexin, IV nafcillin or cefazolin 30“60 minutes before the procedure.
For severe penicillin allergy or suspected MRSA, use clindamycin
or vancomycin.
(FA for IM Boards 2008 Edition)


* Rerotocol Endocarditis Prophylaxis Indication, G


procedures other than "dental procedures" are NO LONGER require antibiotic prophylaxis according to new 2008 revised AHA guidelines for IE prophylaxis.

cardiac Conditions requiring prophylaxis:

1. prosthetic valves
2. previous bacterial endocarditis
3. most CHD, especially cyanotic
4. CHD repaired with prosthetic material or device within last 6 months
5. rapaired CHD with residual defect

Bacteremia requiring prophylaxis

1. Dental procedures, tonsillectomy/adenoidectomy...thats it!!!!!!!!!!!

In short dental procedures with prosthetic heart valves, previous IE or CHD require IE prophylaxis