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Chapter 6: Antibiotic Prophylaxis for Non-Surgical Procedures
Endocarditis Prophylaxis (ESC 2015)
Reserved for patients at highest risk undergoing high-risk procedures.
High-Risk Cardiac Conditions:
- Prosthetic heart valves or repairs
- Previous infective endocarditis
- Certain congenital heart diseases:
- Cyanotic CHD
- <6 months post-prosthetic repair
- Residual shunts or valvular regurgitation at prosthesis site
High-Risk Procedures:
- Dental procedures involving gingival tissue, periapical region, mucosa
- Airway mucosa incisions
- GI/GU procedures if infection is present
Not recommended for:
MVP, bicuspid valves, calcific disease, etc.
Prevention Measures
- Daily dental and cutaneous hygiene
- Disinfect wounds
- Prompt infection treatment
- Avoid tattoos/piercings
- Replace peripheral lines every 3–4 days
Dental Procedures
Indicated for:
- Procedures involving gingival manipulation or mucosal perforation
Not indicated for:
- X-rays, suture removal, local anaesthesia (non-infected), trauma, braces
✅ Dental Prophylaxis Table
Respiratory Procedures
No prophylaxis for:
- Bronchoscopy, intubation, TEE
If infection present:
- Use agents covering strep and staph
GI / Urological Procedures
No prophylaxis unless:
- Active infection
- High-risk patient
Agents should cover enterococci.
Skin/Mucosa Procedures
Indicated if:
- Infected tissue
- High-risk cardiac patients
Use:
- Anti-staph penicillin or cephalosporin
- Vancomycin or clindamycin for allergies
Cardiac/Vascular Implants
Required for:
- Prosthetic valves, grafts, pacemakers
Timing:
- Start 30–60 minutes before incision
- Repeat if surgery >3 hours or significant blood loss
- Stop within 48 hours
Asplenia/Hyposplenia
Risks:
- Encapsulated bacteria (S. pneumoniae, H. influenzae, N. meningitidis)
- Dog bites (Capnocytophaga)
- Severe malaria
✅ Asplenia Vaccination Schedule Table
Rheumatic Fever Prevention
Penicillin prophylaxis:
- Long-acting benzathine penicillin IM every 4 weeks
✅ Benzathine Penicillin Dosing Table
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