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Patients at Risk of Bacterial Endocarditis |
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HIGH RISK: CLASS I ¨ Prosthetic heart valves ¨ Previous infective endocarditis ¨ Complex cyanotic congenital heart disease ¨ Transposition of great arteries ¨ Fallots’ tetralogy ¨ Gerbode’s defect ¨ Surgically constructed systemic pulmonary shunts or conduits ¨ Mitral valve prolapse with mitral regurgitation or thickened valve leaflets
MODERATE RISK: CLASS II ¨ Acquired valvular heart disease eg. Rheumatic heart disease ¨ Aortic stenosis ¨ Aortic regurgitation ¨ Mitral regurgitation ¨ Other structural cardiac defects eg. Ventricular septal defects ¨ Bicuspid aortic valve ¨ Primum atrial septal defect ¨ Patent Ductus Arteriosus ¨ Aortic root replacement ¨ Coarctation of aorta ¨ Atrial septal aneurysm/patent foramen ovale ¨ Ventricular septal defect ¨ Hypertrophic obstructive cardiomyopathy ¨ Subaortic membrane
LOW RISK: CLASS III (NOT REQUIRING ANTIBIOTIC PROPHYLAXIS) ¨ Isolated secundum atrial septal defect ~ ¨ Pulmonary stenosis ¨ Surgically-repaired atrial septal defect ¨ Surgically repaired ventricular septal defect ¨ Surgically repaired patent ductus arteriosus ¨ Post Fontan or Mustard procedure without residual defect/murmur ¨ Previous coronary artery bypass surgery ¨ Isolated secundum atrial septal defect~ ¨ Mitral valve prolapse without regurgitation ¨ Innocent heart murmurs @ ¨ Cardiac pacemakers/defibrillators * $ ¨ Coronary artery stent implantation * ¨ Heart / Heart and Lung Transplant ** ¨ Pulmonary stenosis
~ Antibiotic prophylaxis is recommended for up to 12 months after ASD/PFO catheter-based closure procedures * Unless these procedures are being performed in patients at moderate or high risk of endocarditis when antibiotic prophylaxis is advisable. Antibiotic prophylaxis is not required for patients with previous pacemaker, defibrillator or coronary stent implantation $ Pre and post procedure antibiotics are generally used routinely @ If unsure as to the exact nature of the murmur and the need for prophylaxis, an opinion should be sought from a cardiologist. In an emergency situation or when it is difficult to obtain specific advice then antibiotic prophylaxis should be given to dental or surgical treatment ** Within the first 6 months after heart/ heart-lung transplantation, patients should receive antibiotic prophylaxis.
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