Subacute Bacterial Endocarditis

Antimicrobial prophylaxis is indicated for patients with ‘High Risk’ conditions who are undergoing dental and other procedures.

High risk patients have a greater risk of developing an adverse outcome if Infective Endocarditis were to occur.

As per new regulation, patients with the following conditions require prophylaxis:

• • Prosthetic heart valves, including bioprosthetic and homograft valves.
    
  • Prosthetic material used for cardiac valve repair
  • Prior history of infective endocarditis
  • Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits.
  • Completely repaired congenital heart defects with prosthetic material or device, whether placed by surgery or catheter intervention, during the first 6 months after the procedure.
  • Repaired congenital heart disease with residual defects at the site or adjacent to the site of the prosthetic device.
  • Cardiac valvulopathy in a transplanted heart.

Prophylaxis is No longer indicated in patients with common valvular lesions including:

• • Bicuspid aortic valve
  • Acquired aortic or mitral valve disease (including mitral valve prolapsed with regurgitation)
  • Hypertrophic cardiomyopathy with latent or resting obstruction

The choice of antibiotic is patient and procedure specific.

Dental Procedure: For patients undergoing dental procedure, in majority of individuals is 2mg Amoxicillin orally 30-60 minutes before the procedure. Patients allergic to amoxicillin can be treated with Cephalexin (2g) or Azithromycin or Clarithromycin (500mg) or Clindamycin (600mg).

Non-Dental Procedures: Most patients require amoxicillin or alternative antibiotic therapy.