INFECTIVE ENDOCARDITIS

• Subacute infection / bacterial endocarditis — present in already diseased heart patient conditions like

          o Ventricular septal defect
          o Mitral regurgitation (MR)
          o Valve replacement
          o Down’s syndrome
          o Congenital heart disease

• If surgery done - it will lead to mitral stenosis, bacteremia and septicimia
• Bacteria responsible – streptococcus viridans group: Sanguis , Mitis
• If such patients has to undergo dental procedure that involves gum bleeding – give prophylaxis
• I] Procedures requiring prophylaxis

          o Extraction
          o Banding on molars
          o Intraligamentary injection
          o Scaling (deep)

• II] No prophylaxis needed

          o RCT
          o Bonding
          o Nerve block
          o Supragingival scaling

• PROPHYLAXIS : [I AND II present in patients]

          o Amoxycillin 2grams – most common I E prophylaxis
          o For pedo – amox 50mg/kg body weight (either or or options)****
          o 1⁄2 to 1 hour before the procedure
          o Another choice – cephalosporin prophylaxis
          o If allergic to penicillin and cephalosporin
             - Azithromycin
          o If asthmatic patient under theophylline is allergic to penicillin
             - Ciprofloxacin
             - Because azithromycin is contra indicated to theophylin
          o PROSTHETIC VALVE PATIENT**
             - Prophylaxis is must
             - Than MI or even recent bypass surgery
          o If patient is unconscious and allergic to penicillin
             - Clindamycin , ciprofloxacin

PENICILLIN

• Mech Of Action – inhibit cell wall synthesis
• Complications – urticarial, angioedema, swelling in throat /mouth, wheezing, anaphylaxis
• Rx : 1:1000 adrenaline/epinephrine injection

ANTIPLATELET DRUG

• Bleeding time
• ASPIRIN THERAPY