General Medical Officer (GMO) Manual: Clinical Section

Subacute Bacterial Endocarditis (SBE) Prophylaxis

Department of the Navy
Bureau of Medicine and Surgery
Introduction Operational environment Genitourinary/Gastrointestinal Procedures
Cardiac conditions Standard Oral Regimen Reference
SBE prophylaxis  not recommended Alternate Prophylactic Regimens

Introduction

The need for antibiotic prophylaxis is a very common question. The outline below is a list of the most commonly asked questions concerning the need for antibiotics.

Cardiac conditions

The following conditions are more often associated with endocarditis than others, and so antibiotic prophylaxis is recommended whenever present.

Situations in which endocarditis prophylaxis is not recommended.

  • Secundum atrial septal defect
  • Ventricular septal defect
  • Patent ductus arteriosus.

Operational environment

The following list of procedures is likely to be performed aboard ship or in remote areas and prophylaxis is recommended. This list does not include procedures likely to be performed in a large clinic or hospital.

Endocarditis prophylaxis is not recommended for the following situations.

Standard Oral Regimen

    Amoxicillin

    2 gm orally 1 hr before procedure
    None after initial dose.

    For those allergic to Amoxicillin or Penicillin, use either Erythromycin or Clindamycin

    Erythromycin

    Erythromycin Ethylsuccinate 800 mg orally or Erythromycin sterate 1.0 gm orally, 2 hrs before the procedure.

    Clindamycin

    300 mg orally, 1 hr before the procedure

 

Alternate Prophylactic Regimens for Dental, Oral, or Upper Respiratory Tract Procedures in Patients Who Are at Risk

Drug

Dosing Regimen*

For patients unable to

take oral medications

Ampicillin

IV or IM administration,

2 gm, 30 min before the procedure.

Ampicillin, Amoxicillin and Penicillin allergic patients unable to take oral medications

Clindamycin

Intravenous administration, 300 mg 30 min before the procedure.

Patients considered at high risk and not candidates for standard regimens

Ampicillin, Gentamicin, or Amoxicillin

IV or IM administration of Ampicillin, 2 gm,

plus Gentamicin, 1.5 mg/kg (not to exceed 120 mg),

30 min before procedure; followed by Amoxicillin,

1.5 g, orally 6 h after initial dose.

Alternatively, the parenteral regimen may be

repeated 8 h after initial dose.

Ampicillin, Amoxicillin and Penicillin allergic patients considered

at high risk

Vancomycin plus Gentamicin

IV administration of Vancomycin 1.0 g over 1 hour,

plus Gentamicin1.5 mg/kg IV/IM (not to exceed 120 mg),

complete injection/infusion within 30 minutes of starting

the procedure: no repeat dose is necessary.

Initial pediatric doses are as follows: Ampicillin, 50 mg/kg; Clindamycin, 10 mg/kg; Gentamicin, 1.5 mg/kg; and Vancomycin, 20 mg/kg. Follow-up doses should be one half the initial dose. No initial dose is recommended in this table for Amoxicillin (25 mg/kg is the follow-up dose).

Regimens for Genitourinary/Gastrointestinal Procedures

Drug

Standard Regimen - Dosage Regimen*

Ampicillin, Gentamicin, and Amoxicillin

IV or IM administration of Ampicillin, 2 gm, plus Gentamicin, 1.5 mg/kg (not to exceed 120 mg), 30 min before procedure; followed by Amoxicillin, 1.5 g, orally 6 hours after initial dose;

Alternatively, the parenteral regimen may be repeated once, 8 hours after the initial dose.

Ampicillin, Amoxicillin, and Penicillin allergic patient regimen

Vancomycin and Gentamicin

IV administration of Vancomycin, 1 gm, over 1 hour, plus IV or IM administration of Gentamicin, 1.5 mg/kg (not to exceed 120 mg), 1 hour before procedure.

This may be repeated once, 8 hours after the initial dose.

Alternate low-risk patient regimen

Amoxicillin

3.0 gm orally, 1 hour before the procedure; then 1.5 gm, 6 hours after the initial dose.

 

Initial pediatric doses are as follows: Ampicillin, 50 mg/kg; Amoxicillin, 50 mg/kg; Gentamicin, 2 mg/kg; and Vancomycin, 20 mg/kg. Follow-up doses should be half the initial dose. The total pediatric dose should not exceed the total adult dose.

Reference

    1. Prevention of Bacterial Endocarditis, Recommendations by the American Heart Association, JAMA, 11 June 1997; 277: 1794-1801.

Reviewed by CAPT K. F. Strosahl, MC, USN, Cardiology/Computer Assisted Program of Cardiology Specialty Leader, Cardiovascular Disease Division, Portsmouth Naval Hospital, Portsmouth, VA (1999).

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