Patients undergoing open heart surgery operations, especially with the heart valve prosthesis or artificial or vnutriserdechnymi and intravascular prostheses, are at risk of bacterial Endocarditis. Because of the high morbidity and mortality from Endocarditis, these patients are recommended maximum preventive measures, including preventive antibiotics.
Endocarditis related to the operations open heart surgery, most often caused by Staphylococcus aureus, staphylococcus or koagulazonegativnymi difteroidami. Less frequently streptococcus, gram-negative bacteria and fungi. No single drug-antibiotic, effective against all these microorganisms. Moreover, prolonged use of broad spectrum antibiotics may predispose to superinfection unusual or resistance.
Therefore, prevention cardiosurgery should be primarily directed against staphylococcus and be brief. The most frequently elected penitsillinazoustoychivye penicillin or first generation tsefalosporinov, although the choice of antibiotic should depend on the sensitivity to antibiotics, determined by each hospital. For example, a large spread of infections caused by staphylococcus metitsillinustoychivymi in the facility, should lead to an immediate appointment of vancomycin for preoperative prophylaxis. Profilaktikusleduet begin urgently to the operating procedure and continue no longer than 2 days after surgery to minimize the emergence of resistant microorganisms. One must consider the impact of cardiovascular pulmonalnogo bypass and a violation of renal function in the postoperative period at the level of serum and antibiotics to change doly before and during the proceedings. We recommend a thorough preoperative examination of teeth to hold the required dental treatment and completing it at least a few weeks before the operation on the heart when possible. These measures can reduce the risk postoperatsionnogo Endocarditis.
Antibiotics used for prophylaxis in surgery or instrumental study, urinary or gastrointestinal tract
Standard methods.
Ampicillin, 2 g (50 mg / kg for children) intramuscularly or intravenously (children’s dose should not exceed the maximum adult dose) plus gentamicin, 1.5 mg / kg intravenously or intramuscularly. Children can receive 2 mg / kg. Initial dose should be introduced for half an hour before the procedure can be repeated after 8 hours.
For patients with allergic to penicillin
Vancomycin, 1 g for adults (20 mg / kg, up to 1 g for children) is introduced intravenously, slowly for 1 hour plus gentamicin, 1.5 mg / kg intramuscularly or intravenously (2 mg / kg for children) per 1 hour before the procedure. These doses can be repeated every 1 through 8-12 hours.
Oral drugs for small or repeat procedures in patients with low risk.
Amoxicillin, 3 g (50 mg / kg for children) orally for 1 hour before the procedure and 1.5 g (25 mg / kg for children) at 6 pm (children’s dose should not exceed the maximum adult dose).
Note: in patients with renal function violations may be necessary to amend or repeal the second dose.