Antibiotic Pre-med for Cardiac & Artificial Joint replacement Patients

Infective endocarditis

A microbial infection of the endocardium or heart valves caused by infective agents such as viral, fungal, or bacterial.

Microorganisms that cause IE

• Viridans group streptococci (mouth and the pharynx)

• Staphylococcus aureus (skin)

• Enterococci (GI tract)

Cardiac conditions at Highest Risk

1. Prosthetic cardiac valve

2. Prosthetic material used for cardiac valve repair

3. Previous history of IE

4. A cardiac transplant with valve regurgitation due to a structurally abnormal valve

CHD:

5. Unrepaired Cyanotic CHD

6. Completely repaired defect with prosthetic material or device within 6 months of the procedure

7. Repaired CHD defect with residual shunts of valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or a prosthetic device

8. Surgical or transcatheter pulmonary artery valve conduit placement

Conditions needing antibiotic prophylaxis based on ADA Hhx form

• Prosthetic (artificial) heart valve or material to repair a valve

• Previous infective endocarditis (usually involving valves)

• Damaged valves in transplanted heart

CHD:

• unrepaired, cyanotic CHD

• repaired CHD with residual defects

Antibiotic Prophy procedures

• extractions, dental implant

• placement of otho bands (not brackets)

• perio procedures (probing, SRP, prophy, surgery)

• root canal or surgery beyond the apex

• Injection directly through the PDL

Amoxicillin adult dose

2g

Azithromycin adult dose

500 mg

Clarithromycin adult dose

500 mg

Cephalexin adult dose

2 g

Doxycycline adult dose (Penicillin allergy)

100 mg

____ should not be used in an individual with a history of anaphylaxis, angiodema, or urticaria with penicillin or ampicillin

Cephalosporins

How long before dental treatment should patient take antibiotics?

Up to how long after can antibiotics be given?

30 - 60 mins prior

up to two hours

What antibiotic can kill the three types of microorganisms that cause most cases of infective endocarditis, therefore being the first drug of choice for prevention of IE

Amoxicillin

High Risk TJR patients

TJR patients with risk:

• Immunocompromised/ immuunosuppressed

  • rheumatoid arthritis, systemic lupus

  • drug (e.g. chemo or steroids) or radiation- induced immunosuppression

• Patients with co- morbidities

  • hx or previous joint infection/ failure

  • uncontrolled insulin- dependent diabetics

  • hemophlila

  • HIV or malignancy

Antibiotics used if allergic to penicillins or ampicillin

• Azithromycin or Clarithromycin 500mg

• Cephalexin 2g

• Doxycycline 100mg

Routine dental procedures should be scheduled at least ___ days apart if the same premed is used

10 days

2g of amoxicillin last approx. ___ hours

6 hours

Antibiotics & dosing for at risk TRJ

Amoxicillin 2g

Cephalexin 2g

Doxycycline 100 mg

Cardiac conditions at highest risk that are recommended to receive antibiotic prophylaxis before treatment

• Prosthetic heart valve or material to repair to repair a valve

• previous infective endocarditis (usually involving valves)

• damaged valves in transplanted heart

• CHD:

  • unrepaired, cyanotic CHD

  • repaired CHD with residual defects

What type of antibiotic should NOT be used when anaphylaxis, angiodema, or urticaria with penicillin has occurred

Cephalosporins