INDICES> Bacterial Endocarditits Prophylactic Regimens (cont)

[Beverley Snell <bev@burnet.edu.au>]

INDICES> Bacterial Endocarditits Prophylactic Regimens (cont)
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Hi Richard

Here is the regimen documented for the health service where I worked 
- based on 'Therapeutic Guidelines: Antibiotic' and other 
authoritative references.

Best wishes

Bev
Beverley Snell
International Health Unit, Macfarlane Burnet Centre for Medical Research
P O Box 254 Fairfield Australia 3078
Telephone 613 9282 2115 / 9282 2275
Fax 613 9482 3123
Time zone: 10 hours ahead of GMT.
email <bev@burnet.edu.au>

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Prevention of bacterial endocarditis

Any dental procedure involving mucosal tissue (skin in the mouth) 
infected with bugs can cause a temporary load of infective bugs in 
the mouth.  These bugs (usually Streptococcus pyogenes, S viridans, S 
faecalis or Staphylococcus aureus) can pass into the blood from the 
damaged mouth surface and to damaged heart valves or the heart muscle 
close to any congenital defects in the heart and cause bacterial 
endocarditis.  Antibiotic prophylaxis for prevention of infection by 
these bugs is needed before dental procedures that are known to cause 
bleeding in the mouth for the following groups of patients:
1. Patients with prosthetic heart valves, previous bacterial 
endocarditis, most congenital heart problems, rheumatic heart disease 
or valve disease, coronary stent, coronary artery grafts/bypasses.
2. Patients with hip replacement, implanted tooth
3. Intravenous drug users; the likelihood of introducing bugs that 
can affect the heart through the use of impure substances is quite 
high
4. Patients who are on dialysis.
Consultation with the patient's GP is needed if there is any doubt 
about the patient's condition.
Use
	amoxycillin 3g orally, a single dose 1 hour before the procedure.
	Children:  50 mg/kg up to adult dose.

For patients who are allergic to penicillin, or on long term 
penicillin therapy, or who have taken penicillin or a related 
antibiotic more than once in the previous month, give
	clindamycin 600 mg orally, as a single dose, 1 hour before 
the procedure.
	Children:  10 mg/kg up to adult dose.

Compliance and timing
The dose of amoxycillin 3g reaches its peak in the blood one hour 
after administration.  The concentration starts to fall 90 minutes 
after administration and is less than half after four hours.  For 
protection during a procedure, patients should be given the 
medication and then wait quietly in the health service until the 
procedure begins one hour later.
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