SBE Prophylaxis Recommendations

SBE Prophylaxis 6/00

Give prophylactic antibiotics IF patient ...

is high- or moderate-risk --AND--

is having a procedure with increased risks

Home-Amb-Card-Crit-Neuro-OB-Orth-Pain-Ped-Reg-Tran-Vasc-Misc

Patient Risk Categories

Risk	Medical History
High	prosthetic heart valve history of SBE complex CHD (eg, TOF. transposition great vessel) surgical systemic pulmonary shunts or conduits
Moderate	most other CHD acquired valvular disease hypertrophic cardiomyopathy MVP with insufficiency and/or leaflet thickening
Low	isolated secundum ASD ASD/VSD/PDA 6 mo after repair if no residual history of CABG, pacemaker, or AICD MVP, Kawasaki dz or Rheumatic fever if no valvular dysfunction

Procedure-Associated Risks
(prophylaxis recommended for these procedures IF patient at high or mod risk):

Procedure	Details
Dental	where bleeding is anticipated
Respiratory	T&A, rigid bronch, mucosal surg
GU	prostate, cysto, urethral dil
GI	esophageal varices sclerotherapy or dilation, ERCP, mucosal or biliary tract surg

ANTIBIOTIC REGIMEN
1. Choose antibiotic: Procedure is ...
above the diaphragm
below the diaphragm
2. Determine antibiotic dose

Dental, Oral, Resp, or Esoph Procedures
-std: amox
-npo: amp
-PCN allergy: clinda, cephalexin, or azithromycin
-npo, PCN allergy: clinda or cefazolin

GI, GU (except esophageal) Procedures
-high risk: amp + gent
-high risk, pcn allergy: vanc + gent
-mod risk: amox or amp
-mod risk, PCN allergy: vanc
-high risk: amp + gent

ANTIBIOTIC DOSES
-Amoxicillin 2gm PO 1hr preop
-Ampicillin 2gm IM/IV <30min preop
-Clindamycin 600mg PO 1hr preop or IV <30min preop
-Cephalexin 2gm PO 1hr preop
-Azithromycin or Clarithromycin 500mg PO 1hr preop
-Cefazolin 1gm IM/IV <30min preop
-Gentamicin 1.5 mg/kg up to 120mg
-Vancomycin 1gm IV over 1-2hrs, to finish within 30 minutes of starting procedure