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Prevention of Bacterial Endocarditis: Single dose antibiotic now recommended. The new recommended prophylaxis for endocarditis has been simplified to a single dose which is required one hour prior to the procedure. A follow up dose is no longer recommended. The single recommended dose for children is Amoxicillin (50 mg/kg, not to exceed 2 gms). For individuals that are allergic to penicillin, Clindamycin (20 mg/kg), a first generation cephalosporin (e.g. Cephalexin, 50 mg/kg), Azithromycin or Clarithromycin (15 mg/kg) are acceptable alternatives. Dajani AS, Prevention of Bacterial Endocarditis: highlights of the latest recommendations by the American Heart Association, Pediatr Infect Dis J. 1998;16: 824-825 Comment These recommendations by the American Heart Association (AHA) represent the seventh revision since their first publication in 1955. The most recent recommendation was likely precipitated by the serious threat of antibiotic overuse and it's promotion of resistant microorganisms. In addition, it is now recognized that the incidence of endocarditis following most surgical and dental procedures in patients with underlying cardiac disease is in fact quite low, and most cases of endocarditis are not attributable to the proceeding procedure. Children at highest risk are those with (a) complex cyanotic congenital heart disease, (b) a previous history of endocarditis, (c) surgically-constructed systemic pulmonary shunts or conduits and (d) those with prosthetic heart valves. The most common procedure in paediatrics for which antibiotic prophylaxis is recommended is for dental and oral procedures likely to cause bacteremia including periodontal surgery, scaling and professional teeth cleaning. The genito-urinary tract is second only to the oral cavity as a portal of entry for organisms that may cause endocarditis and surgical procedures involving the respiratory tract including tonsillectomy, adenoidectomy and bronchoscopy are also indications for antibiotic prophylaxis. For the detailed recommendations from the AHA please see Dajani AS et al JAMA, 1997;277:1794-1801.
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