Around PediHeart: Chemoprophylaxis (CPX) Against Endocarditis

Excerpt

Exchanges concerning CPX are surprisingly frequent in PediHeart, considering that convincing evidence for its effectiveness remains absent or marginal. However, CPX remains the standard of care, and its neglect is an invitation for litigation. There are problems when CPX is used for more than a day or two. For example, in a child with chicken pox, the risk of infection with staph persists for more than a week, leading some respondents to recommend a course of anti-staph antibiotics for a child with heart disease. However, the majority of responders worried about developing bacterial resistance, and advocated vigorous hygiene with Phisohex, and vigilance for any evidence of a bacterial superinfection that would indicate antibiotic therapy, as opposed to prophylaxis. Actual skin infections, such as skin abscesses, occasionally lead to bacteremia, and in the cyanotic child, to cerebral abscesses and death. It is difficult to argue against vigorous use of antibiotics for a limited period in this situation. But cutaneous physical prophylaxis, is harmless and more effective in the long run than CPX, just as it is in dental prophylaxis. …