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Author: Admin | 2025-04-28
Are resistant to clindamycin, although this may not be evident in results of in vitro testing. If in vitro susceptibility testing is not possible, results are unknown, or isolates are found to be resistant to erythromycin or clindamycin, a regimen of vancomycin (1 g IV every 12 hours until delivery) should be used for intrapartum prophylaxis in women with penicillin allergy who are at high risk for anaphylaxis.Prevention of Bacterial EndocarditisSome macrolides (azithromycin, clarithromycin) have been recommended for prevention of α-hemolytic (viridans group) streptococcal bacterial endocarditis† [off-label] in penicillin-allergic adults and children with congenital heart disease, rheumatic or other acquired valvular heart dysfunction (even after valvular surgery), prosthetic heart valves (including bioprosthetic or allograft valves), surgically constructed systemic pulmonary shunts or conduits, hypertrophic cardiomyopathy, mitral valve prolapse with valvular regurgitation and/or thickened leaflets, or previous bacterial endocarditis (even in the absence of heart disease) who undergo dental procedures that are likely to result in gingival or mucosal bleeding (e.g., dental extractions; periodontal procedures such as scaling, root planing, probing, and maintenance; dental implant placement or reimplantation of avulsed teeth; root-filling procedures; subgingival placement of antibiotic fibers or strips; initial placement of orthodontic bands; intraligamentary local anesthetic injections; routine professional cleaning) or minor upper respiratory tract surgery or instrumentation (e.g., tonsillectomy, adenoidectomy, bronchoscopy).While erythromycin previously was recommended by the AHA as an alternative to penicillins for prevention of bacterial endocarditis in penicillin-allergic patients, the AHA states that it no longer includes erythromycin in its recommendations because of adverse GI effects and the complicated pharmacokinetics of the various erythromycin formulations. However, the AHA states that practitioners who have successfully used an erythromycin (i.e., erythromycin ethylsuccinate, erythromycin stearate) for prophylaxis in individual patients may choose to continue using these agents. The AHA recognizes that its current recommendations for prophylaxis against bacterial endocarditis are empiric, since no controlled efficacy studies have been published, and that prophylaxis of endocarditis is not always effective. However, the AHA, the ADA, and most clinicians generally recommend routine use of prophylactic anti-infectives in patients at risk for bacterial endocarditis. A national registry established by the AHA in the early
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