Subacute bacterial endocarditis: Prophylaxis

What is subacute bacterial endocarditis? If you think your child may have endocarditis, Subacute bacterial endocarditis (sub-ah-cute call the doctor right away. back-teer-ee-al en-doe-car-dye-tis) is an infection of the inner lining of the heart and the How can I prevent SBE? heart valves. It is very serious because it can With proper precautions, the chances of getting cause destruction of the heart tissue. It is often SBE are less than 1%. SBE prophylaxis called SBE, or simply “endocarditis.” (prevention) involves two major aspects: good dental care for all patients, and antibiotic Bacteria (germs) that cause SBE can get into the protection for patients with the following bloodstream during dental treatment or surgery conditions: of the upper respiratory system. Germs can also • congenital heart disease (CHD) enter the body through unhealthy, inflamed gums, especially if they bleed. Once bacteria get • cyanotic congenital heart disease into the bloodstream, they can reach the heart. (unrepaired) If your child has a heart defect or has had heart • congenital heart defect that has been surgery, there is a small but real risk that the repaired with a patch or device (for the first 6 bacteria will cause endocarditis. months after the procedure)

The treatment for endocarditis is • congenital heart defect that has been hospitalization and up to 6 weeks of repaired with a patch or device, with residual intravenous (IV) antibiotics. Sometimes surgery defects near or at the site is needed to remove bacteria and/or repair • cardiac transplant patients who develop damage caused to the heart. cardiac valve problems

• prosthetic cardiac valve What are the signs of SBE? • history of having endocarditis • unexplained fever

• night sweats Dental care • poor appetite Keep the teeth and gums clean and healthy. This will prevent germs from entering the • muscle and joint aches bloodstream through inflamed tissue and will • no energy prevent the need for most dental repairs or dental surgery. • weight loss • back or chest pain Your child should begin seeing a dentist for regular check ups by the first birthday. Tell the • unusual rashes dentist about your child’s heart condition.

© Children’s Minnesota • Patient & Family Education Revised 12/17

Clean your infant’s teeth from the time the Examples of when antibiotics are not first tooth comes in. Start teaching your child needed include: to brush by 3 years of age. Start flossing when • minor adjustments of braces, when bleeding the spaces between the teeth are closed. Ask is not likely your dentist to show you how to floss your child’s teeth. • losing baby teeth

• cuts, scratches, and stitches in areas outside For children younger than 9 years, parents the mouth should help with the brushing and flossing. • ear tube surgery for uninfected ears Antibiotic protection • cardiac catheterization For at risk patient, it is important to take a prescribed antibiotic before procedures that Some people ask if they need antibiotics before may allow bacteria to enter the bloodstream. body piercing or tattooing. Published studies For dental, oral, or respiratory system haven’t defined the risk, but several doctors procedures, amoxicillin is recommended by the report having seen cases of endocarditis after American Heart Association. If allergic to body piercing and/or tattooing. If you choose to amoxicillin or penicillin, other antibiotics will have these done, your doctor may advise taking be prescribed. antibiotics to lessen the risk of endocarditis. Make sure your skin is very clean beforehand. When scheduled for one of the following procedures, call the clinic for a prescription After the procedure, if you see redness, to give before the procedure: swelling, or drainage, call your doctor right away. • routine dental appointments and teeth cleaning When should I call the cardiology clinic? • getting braces put on Call if your child is scheduled for a procedure • tooth extraction and you do not know whether antibiotics are needed. • cuts in the mouth that need stitches • tonsillectomy or adenoidectomy Questions? • incision and drainage of infected tissue This sheet is not specific to your child, but provides general information. If you have any • bronchoscopy to remove objects in the lungs questions, please call the clinic.

Please call at least 2 days before the For more reading material about this and other procedure. When you call, be ready to give health topics, please call or visit the Family the following information: Resource Center library, or visit our Web site: • child’s name childrensMN.org. • child’s current weight (needed to calculate the correct dose) • preferred preparation: liquid, chewable tablets, or pills to swallow • any allergies to medicines • the pharmacy name and phone number • your name and phone number