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Clinical Reference Systems: Pediatric Advisor 10.0

Prevention of Bacterial Endocarditis Using Antibiotics

What is bacterial endocarditis?

Bacterial endocarditis is a disease of the heart valves or the inner lining of the heart. Bacteria lodge on these structures and begin to grow. Some children with heart defects or heart diseases (such as rheumatic fever) are more likely to get bacterial endocarditis. This condition can sometimes be prevented by taking antibiotic medicine before an operation or other medical or dental procedure.

Your child's doctor has determined that your child should receive antibiotics in the future to reduce the risk of bacterial endocarditis. Always consult your doctor before any upcoming surgery or trip to the dentist about the need for antibiotics.

When should my child take antibiotics?

Dental Procedures:

The most common reason for needing antibiotics for prevention of bacterial endocarditis is when your child has a dental procedure. Your child should receive antibiotics before dental procedures where bleeding is expected, such as:

  • cleaning teeth
  • cutting tissue
  • probing the gums
  • reimplanting a live or a false tooth
  • placing orthodontic bands.

Dental procedures where bleeding is not expected do not require taking antibiotics before hand. These include:

  • filling cavities
  • injecting of anesthetics (painkillers) for dental procedures
  • adjusting of orthodontic devices that are already in place
  • getting fluoride treatments.

Antibiotic treatment is also not necessary when your child loses his or her baby teeth.

Medical Procedures:

Other situations in which your child should receive antibiotics may include:

  • Some operations or procedures that involve the respiratory system including the nose, mouth, and upper part of the airway. They may include removing tonsils or adenoids, or having a rigid bronchoscopy (a procedure in which a scope is inserted into the large airways).
  • Some operations or procedures that involve the stomach and intestinal system including the esophagus (the swallowing tube) and the bile ducts.
  • Some operations or procedures that involve the genitals or urinary system including the bladder and the urethra (the tube that urine goes through).

Some procedures or events involving the respiratory, gastrointestinal, and genitourinary systems do not require antibiotics, including:

  • putting a breathing tube into the airway
  • doing a flexible bronchoscopy
  • putting in ear tubes
  • circumcision.

The decision to use antibiotics is sometimes a complex one. Your doctor(s) may consider many factors before deciding whether to recommend antibiotics for your child. Always consult your doctor if you have any questions about the need for antibiotics.

Be certain to tell your doctor if your child has any allergies to any antibiotics before they are prescribed.

Written by Robert Brayden, MD, Associate Professor of Pediatrics, University of Colorado.
Copyright 1999 Clinical Reference Systems