Grech V. Antibiotic prophylaxis cards for bacterial endocarditis. Images Paediatr Cardiol


*Invited article* (0.2M)	*Grech V. Antibiotic prophylaxis cards for bacterial endocarditis. Images Paediatr Cardiol 2000;2:26-28**
*	Senior Registrar, Paediatric Department, St. Luke's Hospital, Malta

MeSH
Heart defects, congenital	Endocarditis, bacterial	Antibiotic prophylaxis/standards
Bacteremia

Abstract
Infective endocarditis is a largely preventable cause of morbidity and mortality in individuals with congenital heart disease. Patient and physician awareness is crucial, and in this regard, antibiotic prophylaxis cards are very helpful. I present an antibiotic prophylaxis card which is based on recent recommendations by the American Heart Association. This card is currently in use in Malta for both paediatric and adult patients.

Article
Bacteraemia may occur spontaneously, or may be associated with a focal infection or with surgical/dental procedures. Blood-borne bacteria may lodge on abnormal heart valves or near structural defects or on normal endocardium causing endocarditis. Although relatively uncommon, endocarditis is associated with substantial morbidity and mortality despite improvements in antimicrobial therapy and enhanced ability for early diagnosis. Hence, primary prevention of endocarditis is extremely important. The following is the new Maltese antibiotic prophylaxis card (created by the author) which is based on the latest recommendations by the American Heart Association ^1,2. These recommendations reflect analyses of the literature regarding procedure-related endocarditis, and are an update of those drawn up in 1990 ³, incorporating new data which has become available since that time.

The card is meant to be folded in two. The column of the left is the front of the card, while the column on the right is the back. The scope of the card is not only to alert physicians and paramedics to the potential for bacterial endocarditis in the individual patient, but also serves as an aide memoire for recommended regimens and drug dosages. The two columns below summarise the indications and contraindications for antibiotic prophylaxis.

The following table is printed on the inside of the card, and details the actual regimens. Interior of card

This card has been reproduced here in order to help professionals design their own cards, or may be used 'as is' provided that permission is first obtained from the author. The card is physically reproduced as two images. Each image may be download by right-clicking with the mouse on the appropriate image, and choosing the 'save as' option from the short-cut menu.

References

Dajani AS, Taubert KA, Wilson W, Bolger AF, Bayer A, Ferrieri P, Gewitz MH, Shulman ST. Prevention of Bacterial Endocarditis. JAMA 1997;277:1794-1801
Dajani AS, Taubert KA, Wilson W, Bolger AF, Bayer A, Ferrieri P, Gewitz MH, Shulman ST. Prevention of Bacterial Endocarditis. Circulation 1997;96:358-366
Dajani AS, Bisno AL, Chung KJ, Durack DT, Freed M, Gerber MA, Karchmer AW, Millard HD, Rahimtoola S, Shulman ST, et al. Prevention of bacterial endocarditis. JAMA 1990;264:2919-2922

Contact information

Dr. Victor Grech Senior Registrar Paediatric Department St. Luke's Hospital Guardamangia Malta victor.e.grech@gov.mt