Risk |
Medical History |
High |
|
Moderate |
|
Low |
|
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