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PROCEDURE PROPHYLAXIS
(SBE/PROSTHETIC JOINTS) Definition: To prevent bacterial endocarditis in individuals at risk for this disease and/or to prevent joint arthropathies. |
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Procedures Warranting Prophylaxis |
Conditions requiring prophylaxis |
Medications |
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High risk cardiac |
Moderate risk cardiac |
Joint replacement (TJR) |
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Dental: extractions, periodontal, implants, root canal,
cleaning, placement of bands and/or Respiratory: T &/or A, rigid bronchoscopy, surgery of respiratory mucosa and/or GI: Esophageal varices sclerotherapy, stricture dilatation, |
Prosthetic heart valves, previous endocarditis surgical systemic pulmonary shunts |
Acquired valvular dysfunction, hypertrophic cardiomyopathy, mitral valve prolapse with regurgitation and/or thickened leaflets, most congenital heart malformations |
Inflammatory arthropathies, immunosuppression, Type 1 DM, first 2 years post TJR, previous prosthetic joint infection, hemophilia |
Amoxicillin 2.0 g PO 1 hour before or Ampicillin 2.0 g IM 30 min. before or Clindamycin 600 mg or Clarithromycin 500 mg 1 hour before (if PCN allergy) |
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GU: Prostatic surgery, endoscopy, urethral dilatation & non-esophageal GI [ERCP, biliary tract surgery] |
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High risk: Ampicillin 2.0 g IM + Gentamicin 1.5 mg/kg IM 30 minutes before ; 6 hours later Ampicillin 1.0 g IM or Amoxicillin 1 g IM OR Vancomycin 1.0 g IV over 1-2 hours + Gentamicin 1.5 mg/kg IM 30 minutes before (if PCN allergy) Moderate risk: Amoxicillin 2.0 g PO 1 hour before or Amplicillin 2.0 g IM 30 minutes before or Vancomycin 1.0 g IV over 1-2 hours 30 minutes before (if PCN allergy) |
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Reference: Geriatrics At Your Fingertips, 2000 Edition, p. 7-9 JAMA, Revised 10.03 |
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