Infective Endocarditis Prophylaxis Dilemma! - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 08-02-2011
younissmed's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 378
Threads: 68
Thanked 204 Times in 99 Posts
Reputation: 214
Question Infective Endocarditis Prophylaxis Dilemma!

While I was going over the Infective Endocarditis subject in Pediatrics there was a table with the Procedures Recommended For Prophylaxis it included Rigid Bronchoscopy, esophageal varices, dilatation of esophagus, biliary surgery .....etc
The thing is, when I went back to the same subject in the IM book , I found that the exact same procedures are listed under NO NEED FOR PROPHYLAXIS, so what's the deal here ? prophylaxis or not ? or pediatric prophylaxis is different from adult prophylaxis for IE ??
I'm using Kaplan Notes by the way.
thank you.
Reply With Quote Quick reply to this message



  #2  
Old 08-02-2011
cool_atomic's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 472
Threads: 29
Thanked 224 Times in 135 Posts
Reputation: 247
Default

yeah, same question here too!
somebody please explain!
Reply With Quote Quick reply to this message
  #3  
Old 08-02-2011
USMLE-Syndrome's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,203
Threads: 180
Thanked 1,254 Times in 441 Posts
Reputation: 1268
Default

need explain to it toooo

when we give prophyla and when not ????????/
Reply With Quote Quick reply to this message
 
  #4  
Old 08-03-2011
Ace3's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 735
Threads: 89
Thanked 289 Times in 191 Posts
Reputation: 301
Default

Modified recommendations by the American Heart Association (JAMA 277:22:1794, 1997)
Who requires SBE prophylaxis?
  • All unoperated congenital cardiac defects except an uncomplicated atrial septal defect
  • Rheumatic and other acquired valvular abnormalities
  • All postoperative cardiac patients except those with no residua six months following pacemaker implantation, heart transplantation or repair of atrial septal defect, ventricular septal defect or patent ductus arteriosus
  • Any patient with a previous episode of endocarditis even in the absence of underlying heart disease
  • Hypertrophic cardiomyopathy
  • Mitral valve prolapse with regurgitation and/or thickened leaflet
What procedures are indications for SBE prophylaxis?
  • All dental procedures likely to involve bleeding (extraction, cleaning, drilling); however, shedding of primary teeth and adjustment of orthodontic appliances do not require prophylaxis
  • Tonsillectomy, adenoidectomy, bronchoscopy (using rigid bronchoscope) or any surgical procedure involving respiratory mucosa; however, it is not necessary for endotracheal intubation or myringotomy with tube insertion
  • Incision and drainage of infected tissue
  • Any surgical or invasive procedure involving the gastrointestinal or genitourinary system, except for endoscopy without biopsy, urethral catheterization in the absence of infection, hernia repair, circumcision and lacerations not requiring sutures
Regimen for Dental, Oral, Upper Respiratory Tract or Esophageal Procedures

A. All patients
Initial dose: one hour before procedure ORALLY, or 30 minutes before procedure IM or IV.
A Follow-up dose is no longer recommended.
  1. Standard (not allergic to Penicillin) DrugRoute<40kg (88 lbs)>40kg (88 lbs)Amoxicillin
    Oral
    50 mg/kg
    2 gm
    Ampicillin
    IV or IM
    50 mg/kg
    2 gm
  2. Penicillin Allergy or patients on daily rheumatic fever prophylaxis; or patients receiving Penicillin/Amoxicillin. DrugRoute<30kg (66 lbs)>30kg (66 lbs)Clindamycin
    Oral or IV
    20 mg/kg
    600 mg
Regimen for Gastrointestinal/Genitourinary Procedures (excluding esophageal)

A. High-risk patients (prosthetic valve, previous SBE, complex cyanotic heart disease,
systemic to pulmonary shunts or conduits)
  1. Standard (not allergic to Penicillin)
    Initial Dose (IM or IV only): Ampicillin 50 mg/kg (max. 2 gm)
    plus Gentamycin 1.5 mg/kg (max. 120 mg)
    Follow-up Dose (6 hrs. later): Amoxicillin 25 mg/kg (max. 1 gm) orally
    or Ampicillin 25 mg/kg (max. 1 gm)
  2. Penicillin Allergy
    Initial Dose: Vancomycin 20 mg/kg (max. 1 gm) IV over 1-2 hours
    plus Gentamycin 1.5 mg/kg (max. 120 mg)
    Complete infusion within 30 minutes of starting the procedure.
B. All Other Patients
  1. Standard (not allergic to Penicillin)
    Follow recommendations above for dental procedures.
  2. Penicillin Allergy
    Vancomycin 20 mg/kg (max. 1 gm) IV over 1-2 hours,
    complete infusion within 30 minutes of starting the procedure.


ACCORDING TO CHILDRENS HOSPITAL PITS BURGH HOMEPAGE.
Reply With Quote Quick reply to this message
The above post was thanked by:
cerebrum85 (08-05-2011), USMLE-Syndrome (08-03-2011), younissmed (08-03-2011)
  #5  
Old 08-03-2011
Ace3's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 735
Threads: 89
Thanked 289 Times in 191 Posts
Reputation: 301
Default

Here you can find information regarding adult IE prophylaxis:

http://enotes.tripod.com/sbe2003.htm

(This the first time i added and learned how to add link and i found it is soooo easy why i not tried it early)
Reply With Quote Quick reply to this message
The above post was thanked by:
USMLE-Syndrome (08-03-2011), younissmed (08-03-2011)
  #6  
Old 08-03-2011
younissmed's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 378
Threads: 68
Thanked 204 Times in 99 Posts
Reputation: 214
Default

Thank you " Confident " but you listed here Hypertrophic cardiomyopathy& Mitral valve prolapse with regurgitation under conditions requiring prophylaxis while they're listed in Kaplan under conditions that don't , I guess kaplan is messed up in either pediatrics or IM this is ridiculous.
Reply With Quote Quick reply to this message
  #7  
Old 08-04-2011
Ace3's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 735
Threads: 89
Thanked 289 Times in 191 Posts
Reputation: 301
Default

Quote:
Originally Posted by younissmed View Post
Thank you " Confident " but you listed here Hypertrophic cardiomyopathy& Mitral valve prolapse with regurgitation under conditions requiring prophylaxis while they're listed in Kaplan under conditions that don't , I guess kaplan is messed up in either pediatrics or IM this is ridiculous.


yes HOCM is not mentioned for prophylaxis but also not mentioned in dont give...

But MVP KAPLAN says need prophylaxis if associated with MInsufficiency UNDER MVP heading.

And also they said MVP without regugitation under do not give prophylaxis so means MVP with regurgitation need prophylaxis. This is UNDER prophylaxis heading...


Regarding HOCM IE prophylaxis please see article below . They are recommending to give prophylaxis to HOCM so: According to mayo clinic:

http://health.usnews.com/health-conditions/heart-health/hypertrophic-cardiomyopathy/managing
Reply With Quote Quick reply to this message
  #8  
Old 08-04-2011
Kais_MD's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 299
Threads: 26
Thanked 178 Times in 103 Posts
Reputation: 188
Default

Quote:
Originally Posted by confident View Post
yes HOCM is not mentioned for prophylaxis but also not mentioned in dont give...

But MVP KAPLAN says need prophylaxis if associated with MInsufficiency UNDER MVP heading.

And also they said MVP without regugitation under do not give prophylaxis so means MVP with regurgitation need prophylaxis. This is UNDER prophylaxis heading...


Regarding HOCM IE prophylaxis please see article below . They are recommending to give prophylaxis to HOCM so: According to mayo clinic:

http://health.usnews.com/health-conditions/heart-health/hypertrophic-cardiomyopathy/managing
THank you for the criterias..One simple question though...the Empiric TX starts with which one ....ceftriaxone & Vanco....or ...Ceftriaxone & vanco & gent...i am confused plz clarify if anyone knows
Reply With Quote Quick reply to this message
  #9  
Old 08-04-2011
Ace3's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 735
Threads: 89
Thanked 289 Times in 191 Posts
Reputation: 301
Default

Quote:
Originally Posted by Kais_MD View Post
THank you for the criterias..One simple question though...the Empiric TX starts with which one ....ceftriaxone & Vanco....or ...Ceftriaxone & vanco & gent...i am confused plz clarify if anyone knows

I think empiric treatment is ceftriaxone and gentamycin 2weeks im or iv...if penicillin then 6weeks penicillin + 2 weeks gentamycin

If patient is allergic to penicillin then vancomycin+gentamycin 2weeks.

But in vancomycin and gentamycin look for renal function test ..........
Reply With Quote Quick reply to this message
  #10  
Old 08-04-2011
Kais_MD's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 299
Threads: 26
Thanked 178 Times in 103 Posts
Reputation: 188
Default

Quote:
Originally Posted by confident View Post
I think empiric treatment is ceftriaxone and gentamycin 2weeks im or iv...if penicillin then 6weeks penicillin + 2 weeks gentamycin

If patient is allergic to penicillin then vancomycin+gentamycin 2weeks.

But in vancomycin and gentamycin look for renal function test ..........
so its a 2 drug empiric tx..not a 3 drug..... or do u add an extra for neonate and older pple...
Reply With Quote Quick reply to this message



Reply

Tags
Cardiology-, Infectious-Diseases

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Mitral valve prolapse and Infective Endocarditis Prophylaxis Kshitij USMLE Step 2 CK Forum 13 11-08-2011 07:10 PM
prophylaxis for Infective endocarditis, need simple explanation kemoo USMLE Step 2 CK Forum 3 06-29-2011 12:39 PM
prophylaxis for Infective endocarditis kemoo USMLE Step 2 CK Forum 7 06-29-2011 08:50 AM
Infective Endocarditis: Most common infective microorganisms lee-usmle USMLE Step 2 CK Mnemonics 4 05-01-2011 05:21 PM
Infective Endocarditis Prophylaxis annashah USMLE Step 2 CK Forum 1 12-07-2010 12:00 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)