INFECTION PROPHYLAXIS

PRICING INFO


References:

Infection Treatment
Endocarditis prophylaxis for procedures

AHA endocarditis prophylaxis recommendations 2007

  • Prophylaxis is "reasonable" for dental, respiratory tract, skin, and musculoskeletal procedures in the following patients:
    • Prosthetic cardiac valve or prosthetic material used for cardiac valve repair
    • Previous episode of infective endocarditis
    • Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits
    • Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure
    • Repaired Congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
    • Cardiac transplantation recipients who develop cardiac valvulopathy

  • Prophylaxis is NOT recommended for gastrointestinal and genitourinary procedures [1]

  • Recommended treatment regimens:
    • Adults
      • Amoxicillin 2 grams 30 - 60 minutes before procedure
      • Ceftriaxone 1 gram IM 30 - 60 minutes before procedure
      • Cephalexin 2 grams 30 - 60 minutes before procedure (penicillin allergic without severe reaction)
      • Clindamycin 600 mg 30 - 60 minutes before procedure (penicillin allergic)
      • Azithromycin or clarithromycin 500 mg 30 - 60 minutes before procedure (penicillin allergic)
    • Pediatric
      • Amoxicillin 50 mg/kg (max 2 grams) 30 - 60 minutes before procedure
      • Ceftriaxone 50 mg/kg (max 1 gram) IM 30 - 60 minutes before procedure
      • Cephalexin 50 mg/kg (max 2 grams) 30 - 60 minutes before procedure (penicillin allergic without severe reaction)
      • Clindamycin 20 mg/kg (max 600 mg) 30 - 60 minutes before procedure (penicillin allergic)
      • Azithromycin or clarithromycin 15 mg/kg (max 500 mg) 30 - 60 minutes before procedure (penicillin allergic) [17]

NICE endocarditis prophylaxis recommendations 2008

  • Antibiotic prophylaxis for dental, gastrointestinal, genitourinary, and respiratory procedures is not recommended for patients at risk for endocarditis [2]
  • NICE - National Institute for Health and Clinical Excellence

Studies
  • No randomized controlled trials of antibiotic prophylaxis for endocarditis have been performed
  • The AHA guidelines in 2007 recommended cessation of prophylaxis in moderate-risk patients, and the NICE guidelines in 2008 recommended cessation of all prophylaxis
  • A number of observational studies have compared endocarditis incidence rates between time periods before the new guidelines to time periods after. In the U.S., these studies have found no increased incidence of endocarditis. In the U.K. where the NICE guidelines are typically followed, studies have been mixed. The most recent study that spanned 5 years post-NICE guidelines found a significant increase in the incidence of endocarditis in the U.K. [PubMed abstract]

Infection Treatment
Orthopedic implant infection prophylaxis for dental procedures

AAOS recommendations for orthopaedic implant infection prophylaxis

  • In 2017, the American Academy of Orthopaedic Surgeons (AAOS) published guidelines for infection prophylaxis in patients with orthopedic implants who were undergoing dental procedures
  • The information is available on a webpage that makes a recommendation based on patient characteristics that are entered in a form



Infection Treatment
Postexposure
prophylaxis for HIV,
Hepatitis B,
and Hepatitis C

Occupational exposure

  • The University of California at San Francisco provides free, rapid expert consultation and advice on management of occupational HIV, Hepatitis C, and Hepatitis B exposure. They can be contacted by phone or email - UCSF website.

Nonoccupational exposure to HIV (IV drug abuse, sex, etc.)

  • CDC recommendations from 2005
    • If ≤ 72 hours since exposure, treat for 28 days with one of the following:
      • NNRTI-based regimen:
        • Efavirenz 600 mg daily at bedtime; +
        • Lamivudine (150 mg twice daily or 300 mg once daily) OR emtricitabine (200 mg once daily); +
        • Zidovudine (200 mg three times daily or 300 mg twice daily) OR tenofovir (300 mg once daily)

      • Protease inhibitor-based regimen
        • Lopinavir/ritonavir (Kaletra®) 3 tablets twice daily; +
        • Lamivudine (150 mg twice daily or 300 mg once daily) OR emtricitabine (200 mg once daily); +
        • Zidovudine (200 mg three times daily or 300 mg twice daily)

    • Complete CDC recs are available here - CDC website