Chapter: Clinical Cases in Anesthesia : Eisenmenger Syndrome (Subacute Bacterial Endocarditis Prophylaxis)
What are the most likely pathogens involved in subacute bacterial endocarditis and what are the antibiotics of choice for its treatment?
What are
the most likely pathogens involved in subacute bacterial endocarditis and what
are the antibiotics of choice for its treatment?
The most common organism depends on the site of
sur-gery. α-Hemolytic streptococci are the most common cause of endocarditis
following dental procedures. Other procedures around the oropharynx and airway,
such as tonsillectomy and rigid bronchoscopy, also expose the patient to the
same flora. The recommended antibiotic regi-men is outlined in Table 7.1.
Prophylaxis for genitourinary and
gastrointestinal pro-cedures is directed against enterococci. The recommended
antibiotic regimen is outlined in Table 7.2.
Patients at risk for endocarditis who are
scheduled for cardiac surgery should receive prophylaxis against Staphylococcus aureus, staphylococcal
coagulase-negative microbes, and
diphtheroids. A first-generation cephalosporin is most often used; however, the
choice must depend on the pathogen’s susceptibility pattern at each hospital.
To reduce the risk of developing resistant organisms, patients should not be
treated for more than 24 hours.
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