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Infective endocarditis: Prophylaxis

Learning objectives

  • Prevent infective endocarditis

Definition

  • Infective endocarditis (IE) is a life-threatening infection of the endothelial lining of the heart’s chambers and heart valves

Pathophysiology

infective endocarditis, pathophysiology, bacteremia, endothelium, endothelial lining, valve, heart, staphylococcus aureus, platelet, fibrin, complex, vegetation growth, emboli, heart failure, ischemic cerebrovascular accident, infection

Risk factors

High-risk patientsAny prosthetic heart valve
History of IE
Congenital heart disease (CHD):
- Any cyanotic type of CHD
- Any CHD repaired with prosthetic material, up to 6 months after the procedure or lifelong if persistent
the procedure or lifelong if persistent
High
Incision of infected skin tissue
Dental or surgical procedures with manipulation of the gingiva
Root canal treatments
Root extractions

Prophylaxis

  • The absolute risk for IE is very low, and while antibiotics given at the right indication lower the incidence of IE they do not prevent all cases of IE
  • Antibiotic use poses the risk of anaphylaxis or bacterial resistance
  • Consider the pros and cons when giving IE prophylaxis, only use antibiotics for high-risk patients undergoing high-risk procedures
Infected skin tissueDental procedures
No allergy to penicillin or ampicillinFlucloxacilline:
2 g oral, 30-60 min before procedure
Child: 50 mg/kg (max. 1.5 g)
Amoxicillin:
2 g oral, 30-60 min before procedure
Child: 50 mg/kg (max. 2 g)
Penicillin or ampicillin allergy or treatment with penicillin <7 days agoClindamycin:
600 mg oral, 30-60 min before procedure
Child: 20 mg/kg (max. 600 mg)
Clindamycin:
600 mg oral, 30-60 min before procedure
Child: 20 mg/kg (max. 600 mg)
  • Use oral antibiotics as the first choice 
  • Alternatively, use cephalexin 2 g (50 mg/kg IV for children), cefazolin, or ceftriaxone 1 g IV (50 mg/kg IV for children)

Suggested reading

  • Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36(44):3075-3128.

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