Endocarditis prophylaxis for genitourinary and gastrointestinal tract procedures

Bacteraemia associated with genitourinary and gastrointestinal tract procedures predominantly involves enterococci, which are known to cause infective endocarditis. However, antibiotic prophylaxis solely to prevent endocarditis is not routinely recommended for patients undergoing genitourinary or gastrointestinal tract procedures¹.

It is reasonable to include a drug with activity against enterococci (eg ampicillin, amoxicillin)² in the antibiotic regimen for patients with a cardiac condition listed here, who are undergoing a genitourinary or gastrointestinal tract procedure if:

surgical antibiotic prophylaxis is required (see Surgical antibiotic prophylaxis for specific procedures), or
an established genitourinary or gastrointestinal infection is present.

If the regimen for the treatment of an established infection contains an antibiotic with activity against enterococci, adjust timing of the antienterococcal antibiotic 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 (or for vancomycin, see below).

If the treatment or surgical prophylaxis regimen does not include an antibiotic active against enterococci², add:

1 amoxicillin 2 g (child: 50 mg/kg up to 2 g) intramuscularly, 30 minutes before the procedure endocarditis prophylaxis, genitourinary or gastrointestinal tract procedures amoxicillin amoxicillin amoxicillin

OR

1 amoxicillin 2 g (child: 50 mg/kg up to 2 g) intravenously, within the 60 minutes before the procedure amoxicillin amoxicillin amoxicillin

OR

1 ampicillin 2 g (child: 50 mg/kg up to 2 g) intramuscularly, 30 minutes before the procedure endocarditis prophylaxis, genitourinary or gastrointestinal tract procedures ampicillin

OR

1 ampicillin 2 g (child: 50 mg/kg up to 2 g) intravenously, within the 60 minutes before the procedure. ampicillin

For patients with hypersensitivity to penicillins, use:

1 vancomycin (adult and child) 15 mg/kg up to 2 g intravenously, started within the 15 to 120 minutes before the procedure (recommended rate 10 mg/minute) endocarditis prophylaxis, genitourinary or gastrointestinal tract procedures vancomycin

OR

2 teicoplanin 400 mg (child: 10 mg/kg up to 400 mg) intravenously, within the 60 minutes before the procedure. endocarditis prophylaxis, genitourinary or gastrointestinal tract procedures teicoplanin

For patients colonised or infected with vancomycin-resistant enterococci, seek expert advice about an appropriate antibiotic regimen.

¹ In these guidelines, obstetric procedures (eg caesarean section) are not considered to be genitourinary procedures.Return

² Cephalosporins are generally ineffective against enterococci.Return