PairoDocs
Well-known member
There have been some changes in the guidelines. Here are the new ones:
Table 1. Cardiac Conditions for Which Prophylaxis with Dental Procedures is Recommended
Cardiac valvulopathy in a cardiac transplant recipient
Congenital heart disease*
Congenital heart defect completely repaired within the previous six months with prosthetic material or device, whether placed by surgery or by catheter†
Repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or device (which inhibit endothelialization)
Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits
Previous infective endocarditis
Prosthetic cardiac valve
*-Except for the conditions listed, antibiotic prophylaxis is no longer recommended for patients with any other form of congenital heart disease.
†-Prophylaxis is recommended because endothelialization of prosthetic material occurs within six months after the procedure.
Adapted with permission from Wilson W, Taubert KA, Gewitz M, et al.; for the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; the Council on Cardiovascular Surgery and Anesthesia; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Prevention of infective endocarditis [published correction appears in Circulation. 2007;116(15):e376-377]. Circulation. 2007;116(15):1745.
Table 2. Antibiotic Regimens for Patients at High Risk of Infective Endocarditis Undergoing Dental Procedures
Route of administration
Agent
Dosage
Adults
Children
IM or IV
Ampicillin
or cefazolin (Ancef, brand not available in the United States) or ceftriaxone (Rocephin)
2 g IM or IV
50 mg per kg IM or IV
1 g IM or IV
50 mg per kg IM or IV
IV or IM (in patients allergic to penicillin or ampicillin)
Cefazolin or ceftriaxone*
or clindamycin (Cleocin)
1 g IM or IV
50 mg per kg IM or IV
600 mg IM or IV
20 mg per kg IM or IV
Oral
Amoxicillin
2 g
50 mg per kg
Oral (in patients allergic to penicillin or ampicillin)
Cephalexin (Keflex)*†
or clindamycin
or azithromycin (Zithromax) or clarithromycin (Biaxin)
2 g
50 mg per kg
600 mg
20 mg per kg
500 mg
15 mg per kg
IM = intramuscularly; IV = intravenously.
*-Cephalosporins should not be used in patients with a history of anaphylaxis, angioedema, or urticaria after taking penicillin or ampicillin.
†-Or other first- or second-generation oral cephalosporin in equivalent adult or pediatric dosage.
Adapted with permission from Wilson W, Taubert KA, Gewitz M, et al.; for the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; the Council on Cardiovascular Surgery and Anesthesia; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Prevention of infective endocarditis [published correction appears in Circulation. 2007;116(15):e376-377]. Circulation. 2007;116(15):1747.
Table 3. Summary of Major Changes in the Updated AHA Guidelines for Prevention of Infective Endocarditis
Antibiotic prophylaxis is no longer recommended for patients with any form of congenital heart disease except those listed in Table 1
Antibiotic prophylaxis is not recommended based solely on an increased lifetime risk of infective endocarditis
Antibiotic prophylaxis is recommended only for patients with conditions listed in Table 1 who are undergoing dental procedures that involve manipulation of gingival tissues or periapical region of teeth, or perforation of the oral mucosa
Antibiotic prophylaxis is recommended only for patients with conditions listed in Table 1 who are undergoing procedures on the respiratory tract or infected skin, skin structures, or musculoskeletal tissue
Antibiotic prophylaxis solely to prevent infective endocarditis is not recommended for patients undergoing gastrointestinal or genitourinary tract procedures
Prophylaxis for infective endocarditis is not recommended in patients undergoing ear or body piercing, tattooing, vaginal delivery, or hysterectomy
Recommendations for prophylaxis of infective endocarditis should be limited to patients with conditions listed in Table 1
AHA = American Heart Association.
Adapted with permission from Wilson W, Taubert KA, Gewitz M, et al.; for the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; the Council on Cardiovascular Surgery and Anesthesia; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Prevention of infective endocarditis [published correction appears in Circulation. 2007;116(15):e376-377]. Circulation. 2007;116(15):1748.
Sorry if these tables didn't print out exactly. Most of the people in this forum with valve disease need prophylaxis for dental procedures, but not for many other procedures. These are the new AHA guidelines which were reprinted in the February 2008 issue of American Family Physician. There was also mention in the article about waiting 10 days after finishing a course of antibiotics to allow normal flora to re-establish itself. If one is taking antibiotics long-term (this was not defined), prophylaxis with an antibiotic in a different class is recommended, except for cephalosporins. AND, there was no mention of a need to separate dental procedures by 14 days as there was previously. If the pre-procedure dose gets missed, you can take it up to 2 hours after the procedure.
The reason for all this? Chris had to have some dental work done today. Of course, we forgot to ask the dentist to call in for his antibiotics, so I had to do it. He was badly in need of a cleaning, too, because the prolonged intubation he had caused some receding of his gums despite the most excellent care he got to prevent this. He did not and does not have any gingivitis, however. He also broke a couple of teeth recently, and so has to go back for more work, which, supposedly will not involve gingival manipulation.
The AHA still does not know if SBE prophylaxis does any real good! They have found that routine daily activites such as flossing, tooth brushing, chewing, and even using a toothpick are more risky than most dental procedures since they regularly increase the microflora, and now place their emphasis on good dental hygeine, oral care regimens, access to dental care, and avoidance of things that can cause problems with gums and teeth, such as smoking.
Poor dentition and gingival disease may be the single greatest enemy we have in the health care field! It causes preterm labor, low birth weight babies, heart disease, respiratory disease, and sepsis! Who knew? (except for maybe my mom, because she made us bike the 3 miles to the dentist when we had no health insurance because it was "important"). I am very grateful to the dentist who cared for us as children, because he only charged $10 for a visit and cleaning. He explained that we never pulled up in Mercedes as some of his patients did and stated that we couldn't pay our bills. He understood that it was important for our overall health to get good dental care, so he gave us a break.
Sorry this post was so long. I'll let Chris tell you about his visit, which ended up being 3 hours long!
Better Day in Idaho,
-Laura
Table 1. Cardiac Conditions for Which Prophylaxis with Dental Procedures is Recommended
Cardiac valvulopathy in a cardiac transplant recipient
Congenital heart disease*
Congenital heart defect completely repaired within the previous six months with prosthetic material or device, whether placed by surgery or by catheter†
Repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or device (which inhibit endothelialization)
Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits
Previous infective endocarditis
Prosthetic cardiac valve
*-Except for the conditions listed, antibiotic prophylaxis is no longer recommended for patients with any other form of congenital heart disease.
†-Prophylaxis is recommended because endothelialization of prosthetic material occurs within six months after the procedure.
Adapted with permission from Wilson W, Taubert KA, Gewitz M, et al.; for the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; the Council on Cardiovascular Surgery and Anesthesia; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Prevention of infective endocarditis [published correction appears in Circulation. 2007;116(15):e376-377]. Circulation. 2007;116(15):1745.
Table 2. Antibiotic Regimens for Patients at High Risk of Infective Endocarditis Undergoing Dental Procedures
Route of administration
Agent
Dosage
Adults
Children
IM or IV
Ampicillin
or cefazolin (Ancef, brand not available in the United States) or ceftriaxone (Rocephin)
2 g IM or IV
50 mg per kg IM or IV
1 g IM or IV
50 mg per kg IM or IV
IV or IM (in patients allergic to penicillin or ampicillin)
Cefazolin or ceftriaxone*
or clindamycin (Cleocin)
1 g IM or IV
50 mg per kg IM or IV
600 mg IM or IV
20 mg per kg IM or IV
Oral
Amoxicillin
2 g
50 mg per kg
Oral (in patients allergic to penicillin or ampicillin)
Cephalexin (Keflex)*†
or clindamycin
or azithromycin (Zithromax) or clarithromycin (Biaxin)
2 g
50 mg per kg
600 mg
20 mg per kg
500 mg
15 mg per kg
IM = intramuscularly; IV = intravenously.
*-Cephalosporins should not be used in patients with a history of anaphylaxis, angioedema, or urticaria after taking penicillin or ampicillin.
†-Or other first- or second-generation oral cephalosporin in equivalent adult or pediatric dosage.
Adapted with permission from Wilson W, Taubert KA, Gewitz M, et al.; for the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; the Council on Cardiovascular Surgery and Anesthesia; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Prevention of infective endocarditis [published correction appears in Circulation. 2007;116(15):e376-377]. Circulation. 2007;116(15):1747.
Table 3. Summary of Major Changes in the Updated AHA Guidelines for Prevention of Infective Endocarditis
Antibiotic prophylaxis is no longer recommended for patients with any form of congenital heart disease except those listed in Table 1
Antibiotic prophylaxis is not recommended based solely on an increased lifetime risk of infective endocarditis
Antibiotic prophylaxis is recommended only for patients with conditions listed in Table 1 who are undergoing dental procedures that involve manipulation of gingival tissues or periapical region of teeth, or perforation of the oral mucosa
Antibiotic prophylaxis is recommended only for patients with conditions listed in Table 1 who are undergoing procedures on the respiratory tract or infected skin, skin structures, or musculoskeletal tissue
Antibiotic prophylaxis solely to prevent infective endocarditis is not recommended for patients undergoing gastrointestinal or genitourinary tract procedures
Prophylaxis for infective endocarditis is not recommended in patients undergoing ear or body piercing, tattooing, vaginal delivery, or hysterectomy
Recommendations for prophylaxis of infective endocarditis should be limited to patients with conditions listed in Table 1
AHA = American Heart Association.
Adapted with permission from Wilson W, Taubert KA, Gewitz M, et al.; for the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; the Council on Cardiovascular Surgery and Anesthesia; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Prevention of infective endocarditis [published correction appears in Circulation. 2007;116(15):e376-377]. Circulation. 2007;116(15):1748.
Sorry if these tables didn't print out exactly. Most of the people in this forum with valve disease need prophylaxis for dental procedures, but not for many other procedures. These are the new AHA guidelines which were reprinted in the February 2008 issue of American Family Physician. There was also mention in the article about waiting 10 days after finishing a course of antibiotics to allow normal flora to re-establish itself. If one is taking antibiotics long-term (this was not defined), prophylaxis with an antibiotic in a different class is recommended, except for cephalosporins. AND, there was no mention of a need to separate dental procedures by 14 days as there was previously. If the pre-procedure dose gets missed, you can take it up to 2 hours after the procedure.
The reason for all this? Chris had to have some dental work done today. Of course, we forgot to ask the dentist to call in for his antibiotics, so I had to do it. He was badly in need of a cleaning, too, because the prolonged intubation he had caused some receding of his gums despite the most excellent care he got to prevent this. He did not and does not have any gingivitis, however. He also broke a couple of teeth recently, and so has to go back for more work, which, supposedly will not involve gingival manipulation.
The AHA still does not know if SBE prophylaxis does any real good! They have found that routine daily activites such as flossing, tooth brushing, chewing, and even using a toothpick are more risky than most dental procedures since they regularly increase the microflora, and now place their emphasis on good dental hygeine, oral care regimens, access to dental care, and avoidance of things that can cause problems with gums and teeth, such as smoking.
Poor dentition and gingival disease may be the single greatest enemy we have in the health care field! It causes preterm labor, low birth weight babies, heart disease, respiratory disease, and sepsis! Who knew? (except for maybe my mom, because she made us bike the 3 miles to the dentist when we had no health insurance because it was "important"). I am very grateful to the dentist who cared for us as children, because he only charged $10 for a visit and cleaning. He explained that we never pulled up in Mercedes as some of his patients did and stated that we couldn't pay our bills. He understood that it was important for our overall health to get good dental care, so he gave us a break.
Sorry this post was so long. I'll let Chris tell you about his visit, which ended up being 3 hours long!
Better Day in Idaho,
-Laura