SBE Prophylaxis

Risk

Medical History

High
  • prosthetic heart valve
  • history of SBE
  • complex CHD (eg, TOF. transposition great vessel)
  • surgical systemic pulmonary shunts or conduits

Moderate
  • most other CHD
  • acquired valvular disease
  • hypertrophic cardiomyopathy
  • MVP with insufficiency and/or leaflet thickening

Low
  • isolated secundum ASD
  • ASD/VSD/PDA 6 mo after repair if no residual
  • history of CABG, pacemaker, or AICD
  • MVP, Kawasaki dz or Rheumatic fever if no valvular dysfunction

 For dental, oral, respiratory tract or esophageal procedures

  • Amoxicillin 50mg/kg PO 1 hr before or IV at induction
  • Penicillin allergy:
    • Clindamycin 20 mg/kg PO 1 h before
    • Cephalexin or cefadroxil 50 mg/kg PO 1 h before
    • Azithromycin or clarithromycin 15 mg/kg PO 1 h before

For GU/GI procedures

  • High risk: Ampicillin and Gentamicin within 30 minutes of starting procedure; Ampicillin 6 hr later
  • Moderate risk: Amoxicillin 1 hr before

Pathophysiology
Structural heart abnormality with bacteremia = seeding into endocardial erosions

Symptoms

  • Fever
  • Rigor
  • Anorexia
  • Weight loss
  • Anemia
  • Petechial hemorrhage
  • Splinter hemorrhage
  • Splenomegaly
  • Clubbing

Investigations

  • CBCD
  • ESR
  • Blood cultures
  • Echo (TEE for vegetations)

Pathogens

  • Strep viridans
  • Staph aureus, Staph albus

Treatment

  • IV antibiotics x 6 weeks

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