En Do Card It Is

Endocarditis Prophylaxis in Patients with Damaged or Prosthetic Heart Valves There are five potential antimicrobial prophylaxis regimens in patients with damaged or prosthetic heart valves (see BNF prophylaxis section 5.1). The appropriate regimen depends on • the procedure the patient is having • the form of cardiac abnormality they have • whether they are allergic to penicllin or not • whether they have had penicllin in the last month or not Regimen A – Amoxycillin 3g single oral dose taken under supervision 1 hour before procedure Regimen B – Clindamycin 600mg single oral dose taken under supervision 1 hour before procedure Regimen C – Amoxycillin 1g IV at time of induction followed by 500mg PO 6 hours later OR Amoxycillin 3g PO 4 hours before anaesthesia followed by a further 3g PO as soon as possible after the procedure Regimen D – REFER TO HOSPITAL – Amoxycillin 1g IV AND Gentamicin 120mg IV at time of induction then Amoxycillin 500mg PO 6 hours later Regimen E – Teicoplanin 400mg IV AND Gentamicin 120mg IV at time of inmduction OR 15 minutes before procedure

Dental OR Upper Respiratory Tract Procedures under Local Anaesthetic or no anaesthetic

Dental or Upper respiratory tract procedures under general anaesthetic

Risk of Endocarditis

Prosthetic Heart Valve – High Risk

Regimen A if not penicllilin allergic or NOT had penicillin more than one dose in previous month

Regimen A if not penicllilin allergic or NOT had penicillin more than one dose in previous month

History of Endocarditis – Very High Risk Regimen D if not penicllilin allergic or NOT had penicillin more than one dose in previous month

OR

OR

OR

Regimen B if penicllin allergic or HAD more than one dose of penicillin in previous month Regimen C if not penicllilin allergic or NOT had penicillin more than one dose in

Regimen B if penicllin allergic or HAD more than one dose of penicillin in previous month Regimen D if not penicllilin allergic or NOT had penicillin more than one dose in

Regimen E if penicllin allergic or HAD more than one dose of penicillin in previous month Regimen D if not penicllilin allergic or NOT had penicillin more than one dose in

Gastrointestinal Tract Procedures

previous month

previous month

previous month

OR

OR

OR

Regimen E if penicllin allergic or HAD more than one dose of penicillin in previous month None

Regimen E if penicllin allergic or HAD more than one dose of penicillin in previous month Regimen D if not penicllilin allergic or NOT had penicillin more than one dose in previous month

Regimen E if penicllin allergic or HAD more than one dose of penicillin in previous month Regimen D if not penicllilin allergic or NOT had penicillin more than one dose in previous month

OR

OR

If urine infected cover pathogen involved

Regimen E if penicllin allergic or HAD more than one dose of penicillin in previous month If urine infected cover pathogen involved

Regimen E if penicllin allergic or HAD more than one dose of penicillin in previous month If urine infected cover pathogen involved

AND

AND

AND

Regimen D if not penicllilin allergic or NOT had penicillin more than one dose in previous month

Regimen D if not penicllilin allergic or NOT had penicillin more than one dose in previous month

Regimen D if not penicllilin allergic or NOT had penicillin more than one dose in previous month

OR

OR

OR

Regimen E if penicllin allergic or HAD more than one dose of penicillin in previous month

Regimen E if penicllin allergic or HAD more than one dose of penicillin in previous month

Regimen E if penicllin allergic or HAD more than one dose of penicillin in previous month

OR Obstetric and gynaecological procedures

Genitourinary tract procedures