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Cardiac – infective endocarditis fact sheet

Cardiac – infective endocarditis

Infective endocarditis is a serious medical problem which requires hospitalisation and an extensive course of antibiotic treatment.

We all have and need bacteria that grow normally within our bodies. These bacteria, however, cannot always be cleaned away adequately before surgical or dental procedures.

Children with certain structural defects of their heart (repaired and unrepaired), are considered at risk of developing infective endocarditis. Taking antibiotic coverage for those treatments associated with bacteraemia can reduce the risk.

Due to the risk of infective endocarditis, ear and body piercing is not advised for cardiac children.

Children will need antibiotics if they:

  • have a cyanotic heart condition
  • have had cardiac surgery which included use of prosthetic material (for six months after surgery)
  • have had a therapeutic device placed by cardiac catheter (for six months after placement)
  • suffer from a residual defect following cardiac surgery which has included the use of prosthetic material.
  • have had a heart valve replaced or repaired using prosthetic material
  • have been previously diagnosed with infective endocarditis
  • have had a heart transplantation where the heart valves are abnormal
  • are of Aboriginal or Torres Strait Islander descent and have previously been diagnosed with rheumatic heart disease.

When to use antibiotics for prophylaxis

  • Prior to deep cleaning of teeth by a dentist
  • Prior to a tooth being removed (extraction).
  • Prior to mouth surgery.
  • Prior to making a cut (incision in the airways or taking a sample of tissue (biopsy) from the airways (e.g. tonsillectomy).
  • Prior to surgery involving the gut or urinary system when infection is already present.
  • Prior to drainage of an abscess.
  • Prior to surgical incision made through infected skin or muscle.

Please note:
Antibiotic regimes used to prevent recurrences of acute rheumatic fever are inadequate for the prevention of infective endocarditis. Intramuscular injections may be contraindicated in patients receiving anticoagulants.

Information for local medical officers and dentists

Standard prophylactic regimens

  1. Standard general prophylaxis
    Amoxicillin given orally one hour before procedure:
  • Adults – 2 g
  • Children – 50 mg/kg
  1. Unable to take oral medications
    Ampicillin given IM or IV within 30 minutes before procedure:
  • Adults – 2 g
  • Children – 50 mg/kg
  1. Penicillin allergic patients
    Clindamycin given orally one hour before procedure:
  • Adults – 600 mg
  • Children 20 mg/kg
    Vancomycin given as IV infusion every one hour completing just prior to procedure:
  • Adults – 1.5 g
  • Children – 25 mg/kg

Total children’s doses should not exceed adult dose.

Contact us

Queensland Paediatric Cardiac Service (3D)
Level 3, Queensland Children’s Hospital
501 Stanley Street, South Brisbane
t: 07 3068 2790
t: 07 3068 1111 (general enquiries)

In an emergency, always call 000.

If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.

Resource No: FS078. Developed by Queensland Paediatric Cardiac Service. Updated: June 2019. All information contained in this sheet has been supplied by qualified professionals as a guideline for care only. Seek medical advice, as appropriate, for concerns regarding your child’s health.