Endocarditis prophylaxis for respiratory tract or ear, nose and throat procedures

Bacteraemia associated with respiratory tract or ear, nose and throat procedures predominantly involves viridans group streptococci, which are known to cause infective endocarditis. Endocarditis prophylaxis is only recommended for patients with a cardiac condition listed here who are undergoing:

• a tonsillectomy or adenoidectomy¹ —use the regimen in Endocarditis prophylaxis regimens for dental procedures, or
• an invasive respiratory tract or ear, nose and throat procedure to treat an established infection (eg drainage of abscess). Empirical antibiotic treatment should include a drug active against viridans group streptococci. If the infection is suspected or known to be caused by Staphylococcus aureus, also ensure the treatment is active against S. aureus. Adjust the timing of therapy so that an oral dose is administered 60 minutes before the procedure, an intramuscular dose 30 minutes before the procedure, or an intravenous dose within the 60 minutes before the procedure.

Other respiratory tract or ear, nose and throat procedures do not require endocarditis prophylaxis. However, surgical antibiotic prophylaxis may be indicated even if endocarditis prophylaxis is not—see Surgical antibiotic prophylaxis for specific procedures.