Cardiac Prophylaxis for Invasive Procedures
Cardiac prophylaxis for invasive procedures
Adapted from the AHA guidelines
| Examples | Dose for cardiac prophylaxis | ||
| Oral (1 hr pre-op) | IV/ IM (within 30 mins) | ||
| Penicillins | Amoxil suspension (125mg/5ml or 250mg/5ml) Caps (250/ 500mg) | Child: 50mg per kg Adult: 2g | Amoxycillin Ampicillin |
| Cephalosporins (not allergic to Penicillin) | Cephalosporins Ranceph suspension (125mg/5ml or 250mg/5ml) Caps (250/ 500mg) | Child: 50mg per kg Adult: 1g | Cefazolin Ceftriaxone |
| Allergic to Penicillin | Erythromycin Erymycin suspension Caps (250mg) | No longer recommended for cardiac prophylaxis—narrow spectrum | |
| Clarithromycin Clarihexal suspension Klarithran suspension (125mg/5ml or 250mg/5ml) Tabs (250/ 500mg) | Child: 15mg per kg Adult: 500mg | Not IV/ IM | |
| Azithromycin Zithromax suspension (200mg/ 5ml) Caps (250mg) | Child: 15mg per kg Adult: 500mg | Not IV/ IM | |
| Clindamycin Clindamycin-Fresenius suspension Caps (150mg) | Child: 20mg per kg Adult: 600mg | Clindamycin | |
The American Heart Association (AHA), European Society of Cardiology (ESC) and British Society for Antimicrobial Chemotherapy (BSAC) have all put forward guidelines for antibiotic prophylaxis for endocarditis. The United Kingdom’s National Institute for Health and Clinical Excellence (NICE) however recommends that, as there is no evidence to prove the effectiveness of antibiotic prophylaxis, antibiotic cover should only be offered to patients if the procedure is at a site where there is already a suspected infection.
This is however a contentious issue and the AHA and ESC for Cardiology still recommend administering antibiotic prophylaxis in certain high-risk groups viz:
- Replacement valves or prosthetic material used for cardiac valve repair
- Previous episodes of infective endocarditis
- Congenital heart disease
- Unrepaired cyanotic congenital heart disease including palliative shunts and conduits
- Completely repaired using prosthetic material or device during the first 6 months after the procedure (surgical or percutaneous)
- Repaired with residual defect at the site or adjacent to the site of a prosthetic patch or device
- Cardiac transplantation with valvular regurgitation due to a structurally abnormal valve
A recent article by Van der Bijl and Van der Bijl (2014) analysed the evidence in the South African context and concluded that “in the absence of any evidence to the contrary, the guidelines as set forth by the AHA, ESC and BSAC are appropriate”. Antibiotic prophylaxis is therefore still recommended for invasive procedures in high risk groups as stipulated above.
References
Van der Bijl, P and Van der Bijl, P Jr. (2008) Antibiotic prophylaxis for infective endocarditis: New AHA and BSAC guidelines and implications for practice in South Africa. SADJ 63 (4): 240—244.
Van der Bijl, P and Van der Bijl, P Jr. (2014) Infective endocarditis and antibiotic prophylaxis—an update for South African dental practitioners. SADJ 69 (3): 118—121.