감염성 심내막염 highest risk에 해당한 경우 항생제 치료가 필요한 시술은 다음과 같습니다.
㉮ manipulation of gingival tissue or the periapical region of the teeth or perforation of the oral mucosa (tooth extraction, dental abscess drainage)
㉯ procedures involving incision or biopsy of the respiratory tract mucosa ( tonsillectomy, adenoidectomy, obronchoscopy with biopsy)
㉰ surgical procedure for management of infected skin, skin structure, musculoskeletal tissue
㉱ undergoing surgery to place prosthetic heart valves or prosthetic intravascular or intracardiac materials.
Antibiotic regimens for prevention of endocarditis prior to dental and respiratory procedures
|
Situation |
Agent |
Regimen: Single dose* |
|
|
Adults |
Children¶ |
||
|
Oral |
Amoxicillin |
2 g |
50 mg/kg |
|
Unable to take oral medication |
Ampicillin |
2 g IM or IV |
50 mg/kg IM or IV |
|
OR |
|||
|
Cefazolin or ceftriaxoneΔ |
1 g IM or IV |
50 mg/kg IM or IV |
|
|
Allergic to penicillins - oral |
CephalexinΔ◊ |
2 g |
50 mg/kg |
|
OR |
|||
|
Clindamycin |
600 mg |
20 mg/kg |
|
|
OR |
|||
|
Azithromycin or clarithromycin |
500 mg |
15 mg/kg |
|
|
Allergic to penicillins and unable to take oral medication |
Cefazolin or ceftriaxoneΔ |
1 g IM or IV |
50 mg/kg IM or IV |
|
OR |
|||
|
Clindamycin |
600 mg IM or IV |
20 mg/kg IM or IV |
|
|
OR |
|||
|
Vancomycin |
15 to 20 mg/kg, not to exceed 2 g per dose |
15 mg/kg to a maximum dose of 1 g |
|
IM: intramuscular; IV: intravenous; IgE: imunoglobulin E.
* In general, antibiotics should be administered 30 to 60 minutes prior to the procedure; an exception is intravenous vancomycin, which should be administered 120 minutes prior to the procedure. (Refer to the UpToDate topic on antimicrobial prophylaxis for bacterial endocarditis for further discussion.)
¶ The maximal dose in children should not exceed the dose recommended for adults.
Δ Cefazolin or ceftriaxone are alternative agents for patients with nonsevere, non-IgE-mediated penicillin allergy who cannot take oral therapy.
◊ Or other first- or second-generation oral cephalosporin in equivalent adult or pediatric dose.
REF. UpToDate 2020.02.29
