What are the current selection criteria to receive bacterial endocarditis (BE) prophylaxis? Are those with implanted cardioversion devices eligible?
—James K. Eldridge, PA-C, Harstel, Colo.

The risk for BE in patients with pre-existing cardiac disorders is classified as relatively high, moderate, or low. High-risk patients include those with prosthetic heart valves, previous BE, and complex cyanotic congenital heart disease. Moderate risk refers to those with acquired valvular dysfunction (rheumatic heart disease), hypertrophic cardiomyopathy, mitral valve prolapse, and other congenital cardiac malformations. Low risk applies to patients who therapy. BE prophylaxis is also recommended for high- and moderate-risk patients undergoing certain respiratory tract procedures. These include rigid bronchoscopy, tonsillectomy and/or adenoidectomy, and surgical operations that involve the respiratory mucosa.

Prophylaxis is also recommended in high-risk patients undergoing genitourinary tract procedures such as cystoscopy, urethral dilatation, and prostatic surgery; prophylaxis is considered optional for moderate-risk patients. For GI tract procedures such as sclerotherapy for esophageal varices, esophageal stricture dilatation, biliary tract surgery, and surgical operations that involve intestinal mucosa, prophylaxis is recommended for patients at high or moderate risk. These are suggested guidelines, however, and each patient should be individually evaluated with comorbidities taken into consideration.

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The American Heart Association will distribute new guidelines for BE prophylaxis later this year.
—Debra Kleinschmidt, PhD, PA (100-9)