head injury by 80 percent when using skate-
boards, roller skates, and inline skates as well as
for downhill skiing and horseback riding.
Taking small bites and chewing food thor-
oughly before swallowing are important measures
to prevent choking in children and adults. Many
older adults use “scheduled DOSE” medication con-
tainers that may not be child resistant. A signifi-
cant portion of poisonings among children occurs
when children get into their grandparents’ med-
ications. Many medications have coatings that
make them taste sweet, giving children the
impression that they are candy.
KEY PERSONAL MEASURES
FOR PREVENTING ACCIDENTAL INJURIES- wear seat belts and place children under 60 pounds in
appropriate child safety seats in the back seat - wear a helmet when riding a bicycle or horse, downhill ski-
ing, and wheeled skating, and other appropriate safety gear
for sports and athletic activities - store medications in their original labeled containers, with
childproof lids or caps, and in locked cabinets or drawers - install handrails and lighting for stairways and hallways, and
use child gates or child locks to block access to stairs,
kitchens, bathrooms, garages, and other hazardous areas - install handrails in showers and baths, especially for the
elderly - install smoke detectors and put in fresh batteries every six
months - install car horns or buzzers that operate while the vehicle is
in reverse
See also ATHLETIC INJURIES;DOMESTIC VIOLENCE;
FRACTURE; HEAVY-METAL POISONING; HEIMLICH MANEU-
VER; HIP FRACTURE IN OLDER ADULTS; NOISE EXPOSURE
AND HEARING; OCCUPATIONAL HEALTH AND SAFETY; POI-
SON PREVENTION; VIOLENCE.
antibiotic prophylaxis A DOSEor brief course of
ANTIBIOTIC MEDICATIONSbefore invasive dental, sur-
gical, or diagnostic procedures for people who
have had certain HEARToperations or who have
certain heart conditions to help prevent bacterial
ENDOCARDITIS (INFLAMMATIONand INFECTION of the
heart). Doctors may, though do not always, sug-
gest antibiotic prophylaxis for people who have
other heart conditions as well as certain IMMUNE
DISORDERS, HIV/AIDS, type 1 DIABETES, active CANCER,
and women in LABORwho are group B-strep posi-
tive or with prolonged rupture of membranes.
Bacterial endocarditis is a serious infection that
can result in permanent damage to the heart,
especially the heart valves, or in death. The heart
valves are particularly vulnerable to bacteria cul-
tures that establish themselves in their tissues.
This risk increases when there are abnormalities of
blood flow through the heart that can allow blood
to slow or stagnate in the heart’s chambers, or
when there is damage to the valves that prevents
normal movement. Invasive procedures, particu-
larly in the MOUTH(such as tooth extraction or
root canal) and gastrointestinal tract, which are
rich in natural BACTERIA, provide opportunity for
bacteria to enter the bloodstream and travel to the
heart.
The typical regimen is a single large dose of an
antibiotic one hour before the procedure, usually
taken by mouth. The recommended antibiotic is
amoxicillin or cephalexin, azithromycin, or clar-
ithromycin for people who are allergic to peni-
cillin. People who are already taking prophylactic
antibiotics for other purposes should let their doc-
tors or dentists know; the health-care practitioner
will likely choose a different antibiotic for specific
prophylaxis to appropriately target the potential
classification of bacteria.ANTIBIOTIC PROPHYLAXIS ADVISED
When Any of These Conditions Exist
cardiopulmonary shunt cyanoticCONGENITAL HEART DISEASE
HEART TRANSPLANTATION hypertrophic CARDIOMYOPATHY
mitral valve prolapse previous bacterial ENDOCARDITIS
with regurgitation prosthetic heart valve
RHEUMATIC HEART DISEASE uncorrected congenital heart
malformationsBefore Any of These Procedures
CARDIAC CATHETERIZATION CYSTOSCOPY
gastrointestinal ENDOSCOPY periodontal surgery
placement of bands for prophylactic professional dental
braces cleaning
root canal surgery (laparoscopic or open)
tissue biopsy tooth extractionThough numerous studies suggest the value of
antibiotic prophylaxis, none definitively supports
or refutes it, giving rise to some disagreementantibiotic prophylaxis 7