The 9th edition of the Antibiotic Guidelines contains some amendments to the previously published recommendations for endocarditis prophylaxis (Insert, Aust Prescr 1992; 15 (3)). A patient's need for prophylaxis is determined by the proposed procedure and the underlying cardiac problem.

Conditions which indicate a need for prophylaxis include:

  • most congenital cardiac defects
  • previous endocarditis
  • hypertrophic cardiomyopathy
  • mitral valve prolapse with regurgitation
  • prosthetic valve
  • rheumatic and other acquired valvular dysfunction

Procedures which require prophylaxis include:

  • dental procedures likely to cause bleeding
  • rigid bronchoscopy
  • cystoscopy
  • urethral catheterisation or urinary tract surgery in the presence of infection

While many procedures requiring prophylaxis, such as surgery breaching the respiratory, intestinal or genital mucosa, will be carried out in hospital, some procedures will be carried out in the community. For patients not having a general anaesthetic, the following regimens are recommended for dental procedures.

Standard regimen:
A single dose of amoxycillin 3 g (child, 50 mg/kg up to adult dose) one hour before the procedure.

Patients on long-term penicillin or hypersensitive to penicillin or having taken penicillin or a related beta lactam antibiotic more than once in the previous month:

A single dose of clindamycin 600 mg (child 10 mg/kg up to adult dose) one hour before the procedure.

Refer to the 'Antibiotic Guidelines' for advice on prophylaxis for patients having a general anaesthetic or other surgical procedures including skin biopsy.