Clinical Protocols

Protocoles cliniques

Cardiac conditions associated with endocarditis
High-risk category		Moderate-risk category
Prosthetic cardiacs valves, including bioprosthetic and homograft valves Previous bacterial endocarditis Complex cyanotic congenital heart disease (single ventricle states, TOF, transposition of the great arteries) Surgically constructed systemic pulmonary shunts or conduits		Most other congenital cardiac malformations (other than mentioned at left) Acquired valvar dysfunction (e.g., rheumatic heart disease) Hypertrophic cardiomyopathy Mitral valve prolapse with valvar regurgitation and/or thickened leaflets

Recommended prophylactic regimens
Dental procedures (all patients)
	Dental extractions Periodontal procedures including surgery, scaling, and root planing, probing, and recall maintenance Endodontic (root canal) instrumentation or surgery only beyond the apex Subgingival placement of antibiotic fibers or strips Initial placement of orthodontic bands but not brackets Intraligamentary local anesthetic injections Prophylactic cleaning of teeth or implants where bleeding is anticipated

Other procedures
Respiratory tract	Tonsillectomy and/or adenoidectomy Surgical operations that inolve respiratory mucosa Bronchoscopy with a rigid bronchoscope
Gastrointestinal tract 1	Sclerotherapy for esophageal varices Esophageal stricture dilatation Endoscopic retrograde cholangiography with biliary obstruction Biliary tract surgery Surgical operations that involve intestinal mucosa
Genitourinary tract	Prostatic surgery Cystoscopy Urethral dilation
1 For high-risk patients; optional for medium-risk patients

Prophylactic regimens for dental, oral, respiratory tract or esophageal procedures (follow-up dose no longer recommended)
Standard	Amoxicillin: 2.0g PO, 1h before procedure or Ampicillin 2.0g IM ou IV, 30min before procedure

Allergies	Clindamycin: 600mg PO 1h before or Cephalexin or Cefadroxil 2.0g PO 1h before or Azithromycin or Clarithromycin 500mg PO 1h before or Clindamycin 600mg IV, 30min before or Cefazolin 1g IM or IV 30min before

Prophylactic regimens for genitourinary/gastrointestinal procedures
High-risk patients		Moderate-risk patients
Ampicillin2.0g+Gentamicin 1.5mg/kg (max 120mg) IM or IV 30min before 6h later: ampicillin 1g IM or IV or amoxicillin 1g PO Allergies Vancomicin 1g IV over 1-2h & Gentamicin 1.5mg/kg (max 120mg) IM or IV. Complete injection or infusion within 30min before starting procedure		Amoxicillin 2g PO 1h before procedure or Ampicillin 2g IM or IV 30min before procedure Allergies Vancomycin 1g IV Complete infusion within 30 min of starting the procedure

NOTE: for patients already taking an antibiotic, or for other special situations, please refer to the full statement referenced below.

JAMA 1997, 277:1794-1801, Circulation 1997, 96:358-366, and JADA 1997, 128:1142-1150

Déménagement de l'Unité MAUDE: L’Unité Maude est déménagée de l’Hôpital général de Montréal à l’Hôpital Royal Victoria le 22 mai 2007

Un montréalais crée la World Society for Pediatric and Congenital Heart Surgery
Les cardiopathies congénitales, de plus en plus fréquentes chez les adultes et les enfants

L’Unité MAUDE
Hôpital Royal Victoria
687, avenue des Pins ouest,
Salle H4-33
Montreal, Québec Canada
H3A-1A1