Endocarditis prophylactic

Severe renal impairment (Ccr less than 30 mL/min) fondaparinux as prophylactic therapy in patients with body weight less than 50 kg undergoing hip fracture, hip replacement, or knee replacement surgery active major bleeding bacterial endocarditis thrombocytopenia associated with a positive in vitro test for antiplatelet antibody in the presence of fondaparinux known hypersensitivity to fondaparinux. 

Approximately 25% of all patients with hypertrophic cardiomyopathy (HCM) have latent left ventricular outflow obstruction with an intraventricular gradient (I). Pathophysiologic features are asymmetric hypertrophy of the septum and a systolic anterior movement of the anterior leaflet. Medical treatment includes betablockers, and calcium antagonists of the verapamil type. Approximately 5— 10% of the patients with outflow obstruction are refractory to such negative inotropic therapy (2). Positive inotropic drugs such as digitalis or sympathomimetics are strictly contraindicated. In the presence of atrial fibrillation, anticoagulation therapy should be started. Since endocarditis is more common in patients with HCM because of turbulence in the left ventricle, prophylactic antibiotics should be administered for periods of potential bacteraemia. 

The administration of prophylactic antibiotics solely to prevent endocarditis is not recommended for patients who undergo GI tract procedures, including diagnostic esophagogastroduodenoscopy or colonoscopy, as recommended by American Heart Association 2007 guidelines. 

Hall G, Hedstrom SA, Heimdahl A, Nord CE. Prophylactic administration of penicillins for endocarditis does not reduce the incidence of postextraction bacteremia. Clin Infect Dis 1993 17 188-194. 

Prophylactic antibiotics are administered prior to invasive procedures (such as teeth cleaning) so that there will not be an exacerbation of the endocarditis. 

Patients must he fasting for the appropriate duration as determined hy age and health condition. No prophylactic antibiotic is administered before embolotherapy except in children with congenital heart defects for bacterial endocarditis prophylaxis [2]. Sedation at the bedside is prescribed by the anesthesiologist for anxious children and adolescents. 

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