Antibiotic prophylaxis question

Discussion in 'Step II' started by dp101, Aug 13, 2015.

  1. dp101

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    I need some clarification for AB prophylaxis in kids. From what i understand you prophylax if.....
    1) Prosthetic heart valve
    2) history of IE
    3) transplanted heart
    4) Unrepaired CYANOTIC heart disease or a repaired but w/ a defect.
    5) Repaired CONGENITAL HEART DEFECT (not cyanotic) for the first 6 month.

    So if you have a ASD or VSD, which is not repaired, you dont need prophylaxis?
    Lets say you have a repaired VSD, you start 6 months of prophylaxis, after 6 months, no more???

    please help, exam is in 2 days
     
  2. Keto

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    Hi

    With antibiotic prophylaxis in endocarditis, you have to know 3 things: Who gets what for which procedure?
    (Circulation 2007;116:1736-1754.)




    Who gets it?
    1. Prosthetic heart valve or valve repair with prosthetic material
    2. Prior occurrence of endocarditis
    3. Valve abnormality after heart transplant
    4. Certain congenital heart diseases:
      • Unrepaired cyanotic lesions (e.g., Tetralogy of Fallot)
      • Prior repair with residual defects adjacent to prosthetic material
      • Complete repair with prosthetic material, for first 6 months only


    So the list above tells us, who gets prophylaxis - but they don't get it for all procedureS! So.. the second question is when (for which procedures) do you give it?

    • Recommended for invasive dental procedures
      (manipulation of gingival tissue, periapical region of teeth, or
      perforation of oral mucosa)
    • Not recommended for Anesthetic injections, dental x-rays, bleeding from trauma to the lips,...
    • Not recommended for upper respiratory tract
      procedures, unless involves incision or biopsy of
      mucosa (e.g., tonsillectomy, bronchoscopy with biopsy)
    • Not recommended for GU or GI procedures in
      absence of infection



    What do you give?
    • Amoxacillin 2 g 30-60 min prior
    • If allergy: Clindamycin, azithromycin, clarithromycin, cephalexin
    • If parenteral required: Ampicillin, cefazolin, ceftriaxone, clindamycin

    If ASD and VSD is not cyanotic → no prophylaxis needed.

    If the repair is complete, then, according to the current guidelines, no prophylaxis is needed after 6 months.
    If you have residual defects, prophylaxis would be indicated (for the right procedure :) )



    Try this practice question:

    40 yo. woman is scheduled for a tooth extraction. She has a history of a heart condition and her dentist calls to determine if premedication is needed. For which one of the following conditions is antibiotic prophylaxis recommended?

    A. Atrial septal defect with surgical repair 2 years ago
    B. Hypertrophic cardiomyopathy with outflow tract obstruction
    C. Bicuspid aortic valve with severe aortic regurgitation
    D. History of MVP, s/p mitral valve repair (annuloplasty ring), with no residual regurgitation
     
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  3. dp101

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  4. Keto

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    A. Atrial septal defect with surgical repair 2 years ago
    Wrong, "Complete repair with prosthetic material, for first 6 months only".
    B. Hypertrophic cardiomyopathy with outflow tract obstruction
    Wrong, is not an "unrepaired cyanotic lesions".
    C. Bicuspid aortic valve with severe aortic regurgitation
    Wrong, is not an "unrepaired cyanotic lesions".
    D. History of MVP, s/p mitral valve repair (annuloplasty ring), with no residual regurgitation
    Correct
    , Meets criteria; "valve repair with prosthetic material" and also the procedure (tooth extraction) requires prophylaxis. So you would give Amoxicillin 2 g 30-60 min prior to the procedure (if not allergic).
     
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  5. noxe

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    Thanks Keto for the detailed explanation
     

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