Endocarditis prophylaxis

[VCU07]

Quick question-Anyone ever see Ampicillin 4 grams 1hr prior to appt as prophylaxis? I usually see the main ones (Amoxil 2g, Ceph, etc...).

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[Epic]

Quick question-Anyone ever see Ampicillin 4 grams 1hr prior to appt as prophylaxis? I usually see the main ones (Amoxil 2g, Ceph, etc...).

Look at the new IDSA guideline on Prophylaxis.

 

[DrugDealer]

Quick question-Anyone ever see Ampicillin 4 grams 1hr prior to appt as prophylaxis? I usually see the main ones (Amoxil 2g, Ceph, etc...).

Hmmm...it looks like the new guidelines only use ampicillin as a 2g dose, and even then, only IM or IV (they reserve it for pts unable to tolerate an oral med).

 

[Old Timer]

Just to be accurate, the Guidelines are not from the ISDA, but from the American Heart Association and were published in April, 2007 in Circulation.

This is a major change in philosophy and most people who have taken prophylactic antibiotics before routine dental procedures will no longer have to do so.

The only patients how have to take antibiotics to prevent endocarditis are those with:

• Prosthetic cardiac valve
• Previous IE
• Congenital heart disease (CHD)*
• Unrepaired cyanotic CHD, including palliative shunts and conduits
• Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure†
• Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
• Cardiac transplantation recipients who develop cardiac valvulopathy

*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.

 

[Epic]

Stop spoon feeding the students and pharmacists. They need to learn to find the information.

And don't get too cute. IDSA guideline means developed and/or endorsed by.

Just to be accurate, the Guidelines are not from the ISDA, but from the American Heart Association and were published in April, 2007 in Circulation.

This is a major change in philosophy and most people who have taken prophylactic antibiotics before routine dental procedures will no longer have to do so.

The only patients how have to take antibiotics to prevent endocarditis are those with:

• Prosthetic cardiac valve
• Previous IE
• Congenital heart disease (CHD)*
• Unrepaired cyanotic CHD, including palliative shunts and conduits
• Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure†
• Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
• Cardiac transplantation recipients who develop cardiac valvulopathy

*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.

 

[PharmaSynergy]

Quick question-Anyone ever see Ampicillin 4 grams 1hr prior to appt as prophylaxis? I usually see the main ones (Amoxil 2g, Ceph, etc...).

Was this Rx written for a specific patient and you were concerned because the dosage fell outside the clinical guidelines?

Did the patient actually receive that dose?

 

[Old Timer]

Stop spoon feeding the students and pharmacists. They need to learn to find the information.

Are you for real? Since when is providing a link to a journal article and quoting the relevant information spoon feeding?

And don't get too cute. IDSA guideline means developed and/or endorsed by.

First of all I'm not being cute, I'm being accurate. The IDSA did not develop these guidelines. They reported them in an article on their web site. In the article they state:

New practice guidelines from the American Heart Association (AHA) say that taking a precautionary antibiotic before a dental procedure is unnecessary for most patients and may cause more harm than good.

They merely add their endorsement.

 

[Epic]

Are you for real? Since when is providing a link to a journal article and quoting the relevant information spoon feeding?



First of all I'm not being cute, I'm being accurate. The IDSA did not develop these guidelines. They reported them in an article on their web site. In the article they state:


They merely add their endorsement.

Yes. I'm as real as you can imagine. It's spoon feeding when an easy access information pharmacists and students should know where to find is provided without provoking thoughts into their practice process. You don't have to agree.

But I would rather teach them how to fish than give them a fish. You and I are different style of educators.

You can go ahead and call Endocarditis Prevention Guideline as the AHA guideline which isn't wrong, but cute...and I'll tell my students to look to the IDSA guideline to find it where they'll also find other guidelines (both written and endorsed by IDSA) pertaining to antimicrobial therapy.

 

[Epic]

First of all I'm not being cute, I'm being accurate. The IDSA did not develop these guidelines. They reported them in an article on their web site. In the article they state:


They merely add their endorsement.

And no...IDSA did more than just merely add endorsement and reported it in an article. They actually list the full guideline under the Standards, Practice Guidelines, and Statements Developed and/or Endorsed by IDSA along with all other guidelines.

I'm sure you know where that page is.

 

[no-see-um]

And no...IDSA did more than just merely add endorsement and reported it in an article. They actually list the full guideline under the Standards, Practice Guidelines, and Statements Developed and/or Endorsed by IDSA along with all other guidelines.

I'm sure you know where that page is.

Seems to me like both were involved...

I don't think it's necessarily 'spoon-feeding' to cite an article and quote from it. 'Different style educators', as you note, will do it differently. The folks who frequent the forums are at different levels of expertise- some may be just starting, and some may be beyond the 'fishing' stage where an expedient citation is enough, versus having to fish for it one's self. After you've caught 100 fish in your lifetime, and know how to put the bait on the hook and reel it in, is it really necessary to do it the 101st time? Sometimes it's better to put it out there so that it's accessible to those who would not have sought it out, otherwise. The information's just that important.

I come from a long line of educators and I've TA'd courses before and I'd rather put it in front of a student's nose than allow him or her to ignore it. Of course, ideally, your objective of teaching them to find the information of their own is noble, but I'd balance that with exhibiting important information, as well.

There are also MANY pharmacist CE courses that get right to business when it comes to citations and quotes and putting guidelines in a reasonable format leaving the chaff and the thrill of the chase behind. (as far as I know, everyone who posted heretofore but one, is actually a pharmacist)

 

[Epic]

Seems to me like both were involved...

I don't think it's necessarily 'spoon-feeding' to cite an article and quote from it. 'Different style educators', as you note, will do it differently. The folks who frequent the forums are at different levels of expertise- some may be just starting, and some may be beyond the 'fishing' stage where an expedient citation is enough, versus having to fish for it one's self. After you've caught 100 fish in your lifetime, and know how to put the bait on the hook and reel it in, is it really necessary to do it the 101st time? Sometimes it's better to put it out there so that it's accessible to those who would not have sought it out, otherwise. The information's just that important.

I come from a long line of educators and I've TA'd courses before and I'd rather put it in front of a student's nose than allow him or her to ignore it. Of course, ideally, your objective of teaching them to find the information of their own is noble, but I'd balance that with exhibiting important information, as well.

There are also MANY pharmacist CE courses that get right to business when it comes to citations and quotes and putting guidelines in a reasonable format leaving the chaff and the thrill of the chase behind.

I did. I said look at IDSA.

And what you'll find is that Amp 4gram is not in the guideline. Where does that lead to? Well, we know it's outside of the guideline. Does that mean it's wrong? We don't really know. We don't have the pt hx and the circumstances that warrants that kind of dosing. And No, I haven't seen that kind of dosing.

But we all should know that the Sanford Guide and IDSA guidelines are one of the first references we should look to for antimicrobial issues.

 

[Epic]

And I don't like to give my answer to others.

But I like to lead them to their own answer to their own question.

It takes more effort to do so. But it's the most effective way I know to teach students who are making an effort to learn. And we're all students.

 

[Requiem]

And we're all students.

Except you strive for C's.

Sorry, had to

 

[Epic]

Except you strive for C's.

Sorry, had to

In real life, C students hire B students manage A students. Welcome to the world of corporate greed.

 

[alwaystired]

In real life, C students hire B students manage A students. Welcome to the world of corporate greed.

A students seek out every minute detail. C students wait for A students to present their findings.