Infective endocarditis prophylaxis

Bacterial Infections Fungal Infections Viral Infections Protozoal Ineections Parasitic Ineestations Infective Endocarditis Prophylaxis for GI Procedures... 

Cardiac conditions in which prophylaxis is recommended include presence of prosthetic valves, prior infective endocarditis, congenital cardiac abnormalities, rheumatic heart disease or any other valvular dysfunction, hypertrophic... 

Except for the conditions listed above, antibiotic prophylaxis is no longer recommended for any other form of CHD Prophylaxis is recommended because endothelialization of prosthetic material occurs within 6 months after the procedure From Wilson W, TaubertFA, CewilzM,etaL Prevention of infective endocarditis. Grculalion 2007 116 1736-1754 with permission Copyright 2007, American Medical Association. 

It is used in respiratory, genitourinary infections including gonorrhoea, septicemia, meningitis, endocarditis surgical, abdominal, bone and joint infections preoperative prophylaxis in those at increased risk of infection and CNS infections. 

Indications Respiratory infections Bone and joint infection Skin and skin structure infection Urinary tract infection Biliary tract infection Genital infection Septicemia Endocarditis Intra-abdominal infection Surgical prophylaxis Empiric therapy for febrile neutropenic patients... 

Adverse effects are uncommon. Patients taking penicillin prophylaxis are liable to have penicillin-resistant viridans type streptococci in the mouth, so that during even minor dentistry, e.g. scaling, there is a risk of bacteraemia and thus of infective endocarditis with a penicillin-resistant organism in those with any residual rheumatic heart lesion. The same risk applies to urinary, abdominal and chest surg-... 

Durack DT. Prophylaxis of infective endocarditis. In Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases, 5th ed. New York, Churchill-Livingstone, 2000 917-925. 

Penicillin, a naturally occurring antibiotic, is indicated in the treatment of group A streptococcal upper respiratory infections, prophylaxis of poststreptococcal rheumatic fever, syphihs of less than one year s duration, moderate to severe systemic infections, uncomphcated gonorrhea, pneumococcal pneumonia, and endocarditis prophylaxis for dental surgery (see Table 23). 

Penicillin, a natnrally occurring antibiotic, is indicated in the treatment of mild to moderate susceptible infections and endocarditis prophylaxis for dental surgery. 

Vancomycin (500 mg IV q. 6 hours) is indicated for the treatment of severe staphylococcal infections, when other antibiotics are ineffective or contraindicated. Vancomycin (125 to 500 mg p.o. q. 6 hours for 7 to 10 days) is indicated for the treatment of antibiotic-associated pseudomembranous and staphylococcal enterocolitis and vancomycin (1 g IV given slowly over 1 hour, starting 1 hour before a procedure) is indicated for endocarditis prophylaxis for dental, Gl, biliary, and genitourinary instrumentation procedures and... 

Prior to 1997, erythromycin was an alternative antibiotic choice to amoxicillin for prophylaxis prior to dental, oral, esophageal, and respiratory procedures to prevent infective endocarditis (IE). Erythromycin is an alternative choice for treating a recurrence of acute rheumatic fever in patients allergic to penicillin [12]. Recently updated recommendations by the American Heart Association for IE... 

The minimally required duration of treatment is only known for a limited number of infections. Clinical trials have shown the effectiveness of a single dose in the treatment of gonorrhoea or uncomplicated urinary tract infection in women and in surgical prophylaxis. The more precise duration of treatment has been studied for endocarditis, meningitis and staphylococcal bacteraemia. More often, guidelines for duration of treatment have been based on clinical experience with similar infections and on the parameters of response mentioned above. Failure of treatment should be recognised early. It can be due to a variety of reasons (Table 2). 

Various antimicrobials agents is used in dentistry for prevention of local oral wound infection and prevention of distant infection i.e., bacterial endocarditis. Generally, prophylaxis by the use of antibiotics is not required for routine type of dental surgery... 

It is a semisynthetic potent cephalosporin for parenteral administration. It can be administered less frequently because of its long half life. It is used in infections of genitourinary tract, bone, joint and soft tissue infections, septicaemia, endocarditis, gonorrhoea, postoperative chest infections, biliary tract infection and surgical prophylaxis. 

It is used in the treatment of severe anaerobic infections caused by bacteroides and other anaerobes. It is also used in combination with aminoglycoside in the treatment of abdomen and GIT wounds, infections of female genital tract, pelvic abscesses, aspiration pneumonia and septic abortion. It is also used for prophylaxis of endocarditis. It is also used along with primaquine in Pneumocystis carinii pneumonia in AIDS patients and with pyrimethamine for toxoplasmosis. 

Clindamycin is indicated for the treatment of skin and soft-tissue infections caused by streptococci and staphylococci. It is often active against community-acquired strains of methicillin-resistant S aureus, an increasingly common cause of skin and soft tissue infections. Clindamycin is also indicated for treatment of anaerobic infection caused by bacteroides and other anaerobes that often participate in mixed infections. Clindamycin, sometimes in combination with an aminoglycoside or cephalosporin, is used to treat penetrating wounds of the abdomen and the gut infections originating in the female genital tract, eg, septic abortion and pelvic abscesses and aspiration pneumonia. Clindamycin is now recommended rather than erythromycin for prophylaxis of endocarditis in patients with valvular heart disease who are undergoing certain dental procedures. Clindamycin plus primaquine is an effective alternative to trimethoprim-sulfamethoxazole for moderate to moderately severe Pneumocystis jiroveci pneumonia in AIDS patients. It is also used in combination with pyrimethamine for AIDS-related toxoplasmosis of the brain. 

Rifampin is used in a variety of other clinical situations. An oral dosage of 600 mg twice daily for 2 days can eliminate meningococcal carriage. Rifampin, 20 mg/kg/d for 4 days, is used as prophylaxis in contacts of children with Haemophilus influenzae type b disease. Rifampin combined with a second agent is used to eradicate staphylococcal carriage. Rifampin combination therapy is also indicated for treatment of serious staphylococcal infections such as osteomyelitis and prosthetic valve endocarditis. Rifampin has been recommended also for use in combination with ceftriaxone or vancomycin in treatment of meningitis caused by highly penicillin-resistant strains of pneumococci. 

Vancomycin is particularly useful in infections caused by meticillin-resistant or penicillinase-producing staphylococci and diphtheroids, as well as in the prophylaxis of bacterial endocarditis and in the treatment of antibiotic-associated colitis. Sufficient fecal concentrations can be achieved with oral therapy. It is poorly absorbed from the gastrointestinal tract and painful when injected intramuscularly. It diffuses moderately well into bone tissue (6). 

Other, nonlabeled uses of rifampin include the treatment of serious infections such as endocarditis and osteomyelitis caused by methicillin-resistant 5. aureus or 5. epidermidis. Legionnaires disease when resistant to eiythromycin, and prophylaxis of H. injluenaie-induced meningitis. 

Metronidazole has been shown to be of great value in the management of anaerobic bacterial infections [20,27,75,76]. The role of this drug in the prophylaxis and treatment of various anaerobic bacterial infections, which may develop following appendectomy, elective colonic surgery, colo-rectal surgery and hysterectomy [20,77,78]. Mebendazole is equally useful in cases of endocarditis, osteomyelitis, lung abscess, empyema, peritonitis, septicemia and pelvic infections [79]. 

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