Antibiogram

Recent guidelines from the American Heart Association & American College of Cardiology are suggesting antimicrobial prophylaxis only for patients having underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis:

• Prosthetic heart valve
• History of endocarditis

Congenital Heart Disease

• Unrepaired cyanotic CHD, including palliative shunts or conduits
• Completely repaired congenital heart defect with prosthetic material or device during the first six months after the procedure
• Repaired CHD with residual effects at the site or adjacent to the site of a prosthetic patch or device
• Cardiac transplant recipients with cardiac valvular disease.

*Dental, Oral, Respiratory Tract or Esophagel Procedures - Involving incision, biopsy, or respiratory tract or manipulation of gingival tissue, periapical region of teeth or perforation of oral mucosa (Viridans streptococci (alpha-hemolytic streptococci) most prevalent bacteria)

• Treat with agents active against staphylococci and beta-hemolytic streptococci: antistaphylococcal PCN (oxacillin) or cephalosporin (see above doses)
• If MRSA suspected in wound/skin structure: (or intolerant of beta-lactam) Vancomycin 15.20mg/kg for adults up to 2 g or (15mg/kg to 1 g for children)

Prophylaxis solely to prevent endocarditis NOT recommended.

IF: An enterococcal UTI present, treat before an elective GU procedure or include enterococcal coverage perioperatively for non-elective procedures.

IF: exisiting GI or GU infection or receiving perioperative antibiotics to prevent surgical site infection or sepsis, it is reasonable to include an agent with activity against enterococci.