CHEMOPROPHYLAXIS : NON SURGICAL

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Patients with cardiac conditions are considered to be at increased risk of developing Infective Endocarditis (IE) and are indicated for antimicrobial prophylaxis prior to certain procedures.

1.	Prosthetic cardiac valves or prosthetic material used for cardiac valve repair
2.	Established rheumatic heart disease
3.	Previous history of infective endocarditis
4.	Unrepaired cyanotic congenital heart disease (CHD), including palliative shunts and conduits
5.	Completely repaired CHD with prosthetic material or device, for first 6 months after the procedure
6.	Repaired CHD with residual defects at the site or adjacent to the site of the prosthetic device (which inhibit endothelization)
7.	Cardiac transplantation recipients who develop cardiac valvulopathy

Dental Procedures

For patients considered high-risk, antimicrobial prophylaxis is recommended for invasive dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of gingival mucosa.

Even with high cardiac risk of infective endocarditis, antibiotic prophylaxis is not recommended for 

• local anaesthetic injections in non-infected tissues 
• treatment of superficial caries
• removal of sutures
• dental X-rays
• placement or adjustment of removable prosthodontic or orthodontic appliances or braces 
• following the shedding of deciduous teeth
• trauma to the lips and oral mucosa

Respiratory Tract Procedures:

Antimicrobial prophylaxis is recommended for patients with increased risk of IE who undergo an invasive respiratory tract procedure that involve incision or biopsy of the respiratory mucosa. Patients who undergo an invasive respiratory tract procedure to treat an established infection, e.g. biopsy drainage of an abscess, should receive an antibiotic prophylaxis which contains an anti-staphylococcal agent.

Gastrointestinal or genitourinary procedures:

Routine pre-procedural antimicrobial prophylaxis is no longer recommended for patients undergoing genitourinary or gastrointestinal tract procedures. However, for high-risk cardiac patients who have an established gastrointestinal or genitourinary infection, or for those who receive antimicrobial therapy for surgical reasons, the antimicrobial regimen should include an agent active against enterococci, such as Ampicillin or Vancomycin.

Dermatological or musculoskeletal tissue procedures:

For high risk-patients undergoing surgical procedures involving infected skin (including local abscesses), skin structure or musculoskeletal tissue, it is reasonable that the therapeutic regimen contains an agent active against staphylococci and beta-hemolytic streptococci. Vancomycin or Clindamycin may be used in patients unable to tolerate a β-lactam antibiotic. If the infection is known or suspected to be caused by MRSA, Vancomycin or another suitable agent should be administered.