DEPARTMENTAL POLICY AND PROCEDURE
Program:
University of Michigan Cardiovascular Pulmonary Hypertension
Procedure Title:
Antibiotic Prophylaxis
Procedure Written:
July 2011
Reviewed/ Revised: July 2011
Procedure Statement / Purpose: To provide guidelines for timely and safe prescriptions
for the cardiology patient that needs antibiotic prophylaxis for subacute bacterial
endocarditis (SBE)
I.
GUIDELINES
A. Under the direction of the cardiologist at Cardiovascular Medicine, the nurse
assumes responsibility for the management of established Cardiovascular
Medicine Patients requesting antibiotics for SBE prophylaxis.
B. For a patient to receive antibiotics as part of this protocol they must have the
following conditions documented in their medical record.
1. Prosthetic cardiac valves
2. A history of having had infective endocarditis
3. Unrepaired or incompletely repaired cyanotic congenital heart disease,
including those with palliative shunts and conduits.
4. Any repaired congenital heart defect with residual defect at the site of
adjacent to the site of a prosthetic patch or a prosthetic device
5. A completely repaired congenital heart defect with prosthetic material or
device, whether placed by surgery or by catheter intervention during the
first six months after the procedure ie Amplatzer device. Prophylaxis is
recommended for 6 months only because endothelialization of the
prosthetic material occurs within six months after the procedure.
6. Non-coronary vascular grafts need prophylaxis for 6 months post
procedure.
C.
Patients with conditions under B or with documented need for prophylaxis in
the medical record by the cardiologist will need antibiotics before the following
procedures.
1. All dental procedures that involve manipulation of gingival tissue or the
periapical region of teeth or perforation of the oral mucosa.
2. Procedures on the respiratory tract or infected skin, tissues just under the
skin or musculoskeletal tissue.
Revised: 07/2011
D. Antibiotic prophylaxis is not recommended for the following conditions
1. Congenital Heart Disease such as ventricular septal defect, atrial septal
defect and hypertrophic cardiomyopathy
2. Previous CABG
3. Mitral Valve Prolapse
4. Functional heart murmurs
5. Cardiac Pacemakers or defibrillators
6. Placement of coronary stents
7. Rheumatic Heart disease
8. Bicuspid Aortic Valve
9. Calcified Aortic Stenosis
E. Prophylaxis is not recommended for the following procedures
1. Endotracheal intubation
2. Bronchoscopy with flexible bronchoscope, with or without biopsy
3. Tympanostomy tube insertion
4. Transesophageal echo
5. Endoscopy with or without gastrointestinal biopsy
6. Vaginal hysterectomy
7. Vaginal childbirth
8. Uncomplicated Cesarean Section
9. GI or GU procedures
II.
PROPHYLACTIC REGIME
THE NURSE WILL REASSESS THE PATIENT FOR ANY DRUG
ALLERGIES BEFORE USING THIS PROTOCOL
A. Standard: Amoxicillin 2.0 gm orally 1 hour before procedure
Note: RX should read Amoxicillin 500 mg tabs po 1 hour
before procedure quantity 4. Needs for refills should be
assessed based on the number of procedures patient is
anticipating having.
B. Penicillin Allergy: If the patient has an allergy to penicillin the patient should be
given
1. Clindamycin 600 mg po 1 hour before procedure
Or
2. Cephalexin or Cefadrxil 2.0 grams 1 hour before procedure
Or
3. Azithromycin or Clarithromycin 500 mg po 1 hour before
procedure.
Note: Cephalasporins should not be used in individuals with immediate type
of hypersensitivity reaction to penicillins (urticaria, angioedema, and
anaphylaxis.
Revised: 07/2011
III.
REFERENCES
Prevention of Infective Endocarditis. Guidelines From the American Heart
Association. A Guideline From the American Heart Association Rheumatic Fever,
Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease
in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular
Surgery and Anesthesia, and the Quality of Care and Outcomes Research
Interdisciplinary Working Group Circulation 2007: published online before print
April 19, 2007, 10.1161/CIRCULATIONAHA.106.183095.
MD Signature:
___________________________
Date: ____________
Val McLaughlin, MD
Medical Director, CVM Pulmonary Hypertension Program
Nurse Signature:
___________________________
Date: ____________
Janice Norville, MSN, MSBA, RN
Director of Clinical Operations – CVM – Special Programs
Revised: 07/2011