Infective Endocarditis :  All patients with prosthetic valve come under the high-risk category for endocarditis. They need prophylactic antibiotics if any procedure, which is likely to produce bacteremia, is undertaken. The common procedures that require antibiotic prophylaxis are:

I) Surgery involving gastrointestinal mucosa

2) Biliary tract surgery or ERCP

3) Oesophageal dilatation and sclerotherapy

4) Surgery involving respiratory mucous membrane and rigid bronchoscopy

5) Cystoscopy and prostatectomy

6) Any dental procedure that will cause bleeding

7) Tonsillectomy and adenoidectomy.

Recommended Prophylaxis (American Heart Association) in Patients with Prosthetic Valves

Amoxycillin 2 gm orally or clindamycin 600 mg orally one hour before procedure plus gentamycin 1.5 mg/kg IMdV (max 120 mg), thirty minutes before procedure Ampicillin 2 g IV plus gentamycin 1.5 mgkg IM/N, thirty minutes before procedure followed by 2gms of ampicillin or amoxycillin lV six hours after procedure.

If the patient is allergic to penicillin, IV vancomycin one gm plus gentarnycin 1.5mgkg (up to 120mg) thirty minutes before procedure.

Note: If vancomycin is used it should be by a slow infusion ending thirty minutes prior to the procedure.