Bacterial Endocarditis Prophylaxis

The National Heart Foundation (www.heartfoundation.org.nz - see New Zealand Guideline for Prevention of Infective Endocarditis Associated with Dental and Other Medical Interventions) recommends prophylaxis for patients with the following conditions:

prosthetic heart valves (bio or mechanical)
rheumatic valvular heart disease
previous endocarditis
unrepaired cyanotic congenital heart disease (includes palliative shunts and conduits)
surgical or catheter repair of congenital heart disease within 6 months of repair procedure

who are undergoing tonsillectomy, adenoidectomy or dental procedures involving manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa.

Consult with Infectious Diseases for complex patients such as those who have had recent prolonged exposure to antimicrobials.

In This Section

Dental Procedures, Tonsillectomy, and Adenoidectomy

Surgery and Procedures at Sites of Established Infection

Dental Procedures, Tonsillectomy, and Adenoidectomy

amoxicillin

HML Sched NZF PML noids

PO 2000 mg one hour before the procedure, or

IV 2 g just before the procedure, or

IM 2 g 30 minutes before the procedure

Penicillin allergy

clindamycin

HML Sched NZF PML noids

PO 600 mg one hour before the procedure, or

IV 600 mg over at least 20 minutes just before procedure, or

IM 600 mg 30 minutes before the procedure

Metabolised by CYP3A. (fe < 0.1).

If the antimicrobial has been missed it can be given up to 2 h post-procedure.

Surgery and Procedures at Sites of Established Infection

Treatment regimens should include the following antimicrobials:

	First-line	Second-line
Dental or upper respiratory tract	amoxicillin	clindamycin (penicillin allergy)
Gastrointestinal, hepatobiliary, genitourinary, obstetric/gynaecological	amoxicillin	vancomycin (penicillin allergy)
Skin, skin structure, or musculoskeletal infections	flucloxacillin	cefazolin (mild penicillin allergy) clindamycin (severe penicillin allergy or MRSA)

Topic Code: 99213