PROCEDURE PROPHYLAXIS (SBE/PROSTHETIC JOINTS)

Definition: To prevent bacterial endocarditis in individuals at risk for this disease and/or to prevent joint arthropathies.

Procedures

Warranting

Prophylaxis

Conditions requiring prophylaxis

Medications

High risk cardiac

Moderate risk cardiac

Joint replacement (TJR)

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)

GU: Prostatic surgery, endoscopy, urethral dilatation & non-esophageal GI

[ERCP, biliary tract surgery]

 

 

 

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)

Reference: Geriatrics At Your Fingertips, 2000 Edition, p. 7-9

JAMA, June 11, 1997, p. 1794-1801, JADA, 1997; 128, 1004-1007.

Revised 10.03

 

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