Antibiotic prophylaxis 6 7

Low-risk patients (no prosthetic valves or previous attack of endocarditis):

• amoxycillin 3 g (50 mg/kg up to adult dose) orally, 1 hour beforehand (if not on long-term penicillin), then 1.5 g (o) at 6 hours or

• (amoxy) ampicillin 1 g (50 mg/kg up to adult dose) IV just before procedure commences or IM 30 minutes before if having a general anaesthetic, followed by 500 mg, 6 hours later.

If hypersensitive to penicillin: vancomycin or teicoplanin or clindamycin.

High-risk patients (prosthetic valves or previous attacks of endocarditis), having dental procedures, oral surgery or upper respiratory tract surgery, GIT or GU surgery, cardiac catheterisation or temporary pacemaker insertion:

• (amoxy) ampicillin 1 g IV or IM (as above) with 500 mg, 6 hours later plus

• gentamicin 1.5 mg/kg (2.5 mg/kg in children to maximum dose 80 mg) IV (just before) or IM (30 minutes before).

If hypersensitive to penicillin: vancomycin or teicoplanin plus gentamicin.

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