Practice parameters for antibiotic prophylaxis to prevent infective endocarditis or infective prosthesis during colon and rectal endoscopy.

SOURCE(S):
Dis Colon Rectum 2000 Sep;43(9):1193-200 [61 references]

Practice Parameters for Antibiotic Prophylaxis

Bacterial endocarditis is a serious, potentially fatal condition that may be associated with endoscopic procedures. Antibiotic prophylaxis has been used to prevent endocarditis, but does involve risks. Endoscopists must assess the evidence and weigh the risks and benefits. It is the consensus of The Standards Task Force that antibiotic prophylaxis be considered only for the high-risk groups.

Conditions Associated with Endocarditis

High risk

· Prosthetic cardiac valves

· History of endocarditis

· Surgically constructed systemic pulmonary shunts

· Complex cyanotic congenital heart disease

· Vascular grafts (first 6 months after implantation)

Moderate risk

· Most other cardiac malfunctions

· Acquired valvular dysfunction

· Hypertrophic cardiomyalgia

· Mitral valve prolapse with valvular regeneration or thickened valves or both

Low risk

· Vascular graft material (6 months after implantation)

· Orthopedic prosthesis

· Central nervous system ventricular shunts

· Penile prosthesis

· Intraocular lens

· Pacemakers

· Local tissue augmentation material

· Isolated secundum atrial septal defect

· Previous coronary bypass

· Mitral valve prolapse without valvular degeneration

· Physiologic heart murmurs

· Previous rheumatic fever without valvular dysfunction

· Cardiac pacemaker

It is the consensus of The Standards Task Force that antibiotic prophylaxis be considered only for the high-risk groups.

Nonvalvular and Noncardiac Prosthesis

Prophylactic Regimens

It is impossible to make recommendations for all clinical situations. Practitioners must choose the anti-biotic and determine the dosage based on the special circumstances of each case. Adult prophylactic regimens listed in the table below are representative of recommendations made by the American Heart Association (AHA). Although the other organisms may be cultured after lower endoscopy, enterococcus is the most likely cause of endocarditis; therefore, the prophylactic regimens are directed primarily against enterococci.

Adult Prophylactic Regimens:

Drug	Adult Dosage Regimen
Ampicillin, gentamicin, and amoxicillin	Intravenous or intramuscular administration of ampicillin (2.0 g) plus gentamicin (1.5 mg/kg; not to exceed 120 mg) 30 minutes before procedure, followed by amoxicillin (1 g) orally 6 hours after initial dose or ampicillin 1 g intramuscularly or intravenously.
Vancomycin and gentamicin*	Intravenous administration of vancomycin (1.0 g) over 1 to 2 hours plus intravenous or intramuscular administration of gentamicin (1.5 mg/kg; not to exceed 120 mg), complete infusion within 30 minutes of starting procedure.
Amoxicillin** or ampicillin	Amoxicillin 2 g orally or ampicillin 2 g intramuscularly or intravenously within 30 minutes of starting procedure.

*Ampicillin or amoxicillin or penicillin-allergic regimen.

**Alternative moderate-risk regimen.

CLINICAL ALGORITHM(S):
None provided

DEVELOPER(S):
American Society of Colon and Rectal Surgery (ASCRS) - Medical Specialty Society

COMMITTEE:
Standards Task Force, American Society of Colon and Rectal Surgeons

GROUP COMPOSITION:
Task Force Members: Greg Oliver, M.D., Project Director, Ann Lowry, M.D., Committee Chair, Anthony Vernava, M.D., Vice Chairman, Terry Hicks, M.D., Council Representative, Marcus Burnstein, M.D., Frederick Denstman, M.D., Victor Fazio, M.D., Bruce Kerner, M.D., Richard Moore, M.D., Walter Peters, M.D., Theodore Ross, M.D., Peter Senatore, M.D., Clifford Simmang, M.D., Steven Wexner, M.D., W. Douglas Wong, M.D.

ENDORSER(S):
Not stated

GUIDELINE STATUS:
This is the current release of the guideline. This guideline updates a previously issued guideline (Practice parameters for antibiotic prophylaxis to prevent infective endocarditis or infected prosthesis during colon and rectal endoscopy. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum 1992 Mar;35[3]:277).

GUIDELINE AVAILABILITY:
Electronic copies: Available from the American Society of Colon and Rectal Surgeons (ASCRS) Web site.

Print copies: Available from ASCRS, 85 W. Algonquin Road, Suite 550, Arlington Heights, Illinois 60005.

COMPANION DOCUMENTS:
The following is available:

· Oliver G, Lowry A, Vernava A, Hicks T, Burnstein M, Denstman F, Fazio V, Kerner B, Moore R, Peters W, Ross T, Senatore P, Simmang C, Wexner S, Wong Practice parameters for antibiotic prophylaxis--supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum. 2000 Sep;43(9):1194-200.

Electronic copies: Available from the American Society of Colon and Rectal Surgeons (ASCRS) Web site.

Print copies: Available from ASCRS, 85 W. Algonquin Road, Suite 550, Arlington Heights, Illinois 60005.

Edward E. Rylander, M.D.

Diplomat American Board of Family Practice.

Diplomat American Board of Palliative Medicine.