BACTERIAL-ENDOCARDITIS PROPHYLAXIS - WHAT IS RECOMMENDED AND WHAT IS PRACTICED

Study Objective: To determine how often pediatric anesthesiologists fo llow the American Heart Association (AHA) recommendations for the admi nistration of prophylactic antibiotics to prevent bacterial endocardit is (BE). Design: Questionnaires mailed to all members of the Society f or Pediatric Anesthesia regarding their use of antibiotics to prevent BE. Setting: Anesthesia department at a university-affiliated children 's hospital. Measurements and Main Results: 898 questionnaires were ma iled, and 465 questionnaires were returned, yielding a response rate o f 52 %. When anesthesiologists administer BE prophylaxis intravenously (IV), they perform an inhalation anesthetic 76 % of the time prior to establishing IV access. Ninety percent of the respondents stated that if administration. of antibiotics occurs after a mash induction, they do not delay incision or instrumentation for 30 minutes. Therefore, r espondents do not follow AHA recommendations for BE prophylaxis 55 % o f the time. Of the 465 respondents, only 4 recalled pediatric patients who developed perioperative BE. Conclusions: The majority of anesthes iologists responding to this survey routinely do not follow the curren t AHA recommendations for BE prophylaxis when caring for children. Sin ce there are no studies demonstrating that administering antibiotics 3 0 minutes prior to invasive procedures is more effective than administ ering antibiotics immediately prior to invasive procedures, it may be appropriate to follow a time sequence that is more comfortable and con venient for pediatric patients. We believe that a reconsideration of t he current AHA recommendations for BE prophylaxis is warranted.