manipulative procedure that will cause a significant bacteraemia then antibiotic
prophylaxis is needed.
- Assessment of antibiotic prophylaxis regimen: choice, dosage, and mode of
administration (1093HTables 16.4 and 1094H16.5)
- The choice of regimen is determined by the use of anaesthesia and analgesia.
- For multiple visits of treatment under local anaesthesia a period of 1 month
should elapse before a second dose of the same antibiotic is given. Alternating the
sequence of antibiotic between visits (e.g. penicillin then clindamycin) can be used to
overcome this need to wait 1 month before the next visit. - The need for general anaesthesia or intravenous sedation requires a modification
of the drug regimen particularly in regard to dosage. - Those patients with highest risk of infective endocarditis, for example, prosthetic
heart valves or previous infective endocarditis. (1) Not allergic also require
gentamycin and postoperative amoxicillin; (2) Penicillin allergic⎯require
vancomycin and gentamycin.
Children who have had corrective surgery for a patent ductus arteriosus and those
who have received a heart-lung transplant are considered to have normal hearts and
only require prophylactic antibiotics for the initial 6 months following surgery. Those
who had an atrial septal defect corrected using a catheter-based procedure require
prophylactic antibiotics for 12 months following surgery. If in doubt, contact the
child's cardiologist!
Key Points
Antibiotic prophylaxis considerations:
- Assessment of cardiac risk,
- Assessment of the risk of significant bacteraemia associated with the dento-gingival
manipulative procedure, - Assessment of antibiotic prophylaxis regimen: choice, dosage, and mode of
administration.
16.3 DISORDERS OF THE BLOOD
16.3.1 Bleeding disorders
The blood is in a dynamic equilibrium between fluidity and coagulation, but the
haemostatic mechanism is more complex than just alterations in this equilibrium. It
involves local reactions of the blood vessels, platelet activities, and the interaction of
specific coagulation factors that circulate in the blood. In early childhood many of the
bleeding disorders have a genetic background but with increasing age more become
iatrogenic⎯usually due to anticoagulant medication. Patients who have had cardiac
surgery for some congenital abnormality, those who have had a recent myocardial
infarction, and those who have had cerebrovascular accidents may all be receiving
long-term anticoagulant therapy. 1095HTable 16.6 gives a classification of bleeding
disorders based on disorders of coagulation, bleeding problems due to decreased
numbers of platelets, and disorders of bleeding where there are normal numbers of
platelets. Many of these conditions are very rare and will not be considered further.