วันเสาร์ที่ 7 สิงหาคม พ.ศ. 2553

708. Bacterial endocarditis prophylaxis

มีแนวทางในการให้ยาปฎิชีวนะ Bacterial endocarditis prophylaxis อย่างไร

The American Heart Association แนะนำให้ยาปฎิชีวนะ bacterial endocarditis prophylaxis ในกลุ่มผู้ป่วยที่มีความเสี่ยงสูง
โดยแบ่งความเสี่ยงเป็นดังนี้
Highest risk — People with the following conditions are considered to be at the highest risk of developing infective endocarditis. Preventive antibiotics are generally recommended for people with the following conditions before certain procedures:
* A mechanical prosthetic heart valve
* Natural prosthetic heart valves obtained from animals or cadavers
* Valve repair with prosthetic material
* A prior history of infective endocarditis
* Most congenital (from birth) heart abnormalities such as single ventricle states, transposition of the great arteries, and tetralogy of Fallot, even if the abnormality has been repaired
Moderate risk — People with the following conditions are considered to be at moderate risk of developing infective endocarditis. Antibiotic prophylaxis is NOT generally recommended for people with moderate risk conditions. This is an important change from prior recommendations
* Valve repair without prosthetic material
* Hypertrophic cardiomyopathy
* Mitral valve prolapse with valvular regurgitation and/or valvular thickening
* Most other congenital cardiac abnormalities not listed above
* Unrepaired ventricular septal defect, unrepaired patent ductus arteriosus
* Acquired valvular dysfunction (eg, mitral or aortic regurgitation or stenosis)
* Atrial septal defect, ventricular septal defect, or patent ductus arteriosus that was successfully closed (either surgically or with a catheter based procedure) within the past six months
Low risk — People with the following conditions are thought to have a low risk of infective endocarditis. Antibiotics have never been recommended for people with these conditions:
* Physiologic, functional, or innocent heart murmurs
* Mitral valve prolapse without regurgitation or valvular leaflet thickening
* Mild tricuspid regurgitation
* Coronary artery disease (including previous coronary artery bypass graft surgery)
* Simple atrial septal defect
* Atrial septal defect, ventricular septal defect, or patent ductus arteriosus that was successfully closed (either surgically or with a catheter based procedure) more than six months previously
* Previous rheumatic fever or Kawasaki disease without valvular dysfunction
* People with pacemakers or defibrillators

อ่านรายละเอียดเพิ่ม: http://www.medcardiology.com/treatment-of-heart-diseases/108-antibiotics-before-procedures

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