Expansion
Surgical, medical and post-exposure indications
Expansion
Surgical prophylaxis
- A single dose within 60 minutes of incision, repeated only for prolonged surgery or major blood loss
- Indicated for clean-contaminated and contaminated surgery, and clean surgery involving a prosthesis
- Continuing beyond 24 hours provides no benefit and increases resistance and Clostridioides difficile
Medical prophylaxis
- Asplenia or hyposplenism: lifelong penicillin, plus vaccination against encapsulated organisms
- Recurrent urinary tract infection, recurrent cellulitis
- Rheumatic fever, to prevent recurrence
- HIV with low CD4: co-trimoxazole against Pneumocystis
- Immunosuppression and neutropenia in selected patients
Post-exposure prophylaxis
- Meningococcal contacts: ciprofloxacin
- Pertussis, tuberculosis contacts
- HIV post-exposure prophylaxis after needlestick or sexual exposure
- Human and animal bites: co-amoxiclav
Infective endocarditis prophylaxis is no longer routinely recommended in the UK for dental or other procedures, a change that surprises many. Emphasis is on oral health and prompt treatment of infection instead.