SBE prophylaxis in children
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What is SBE prophylaxis?
Some parents have been told that their child may require antibiotics or “SBE prophylaxis” prior to visiting the dentist or having any surgical procedures done. So what is SBE prophylaxis and why do some children with heart disease need this precaution?
SBE, “Subacute Bacterial Endocarditis”, or endocarditis for short, is a rare bacterial infection of the inner lining of the heart muscle and/or heart valves. The bacteria which cause this infection can enter into a person’s blood stream during routine dental cleanings or certain surgical procedures that involve the mouth, throat or airway. In patients with certain types of heart defects, the risk of the bacteria infecting the heart and causing damage to the heart lining or heart valves is relatively high. Patients who develop this infection require treatment with long term IV antibiotics (up to 2 months) and close monitoring to be sure that the valves are not injured. Sometimes, surgery may be required to remove the infected area and repair any damage to the heart.
Who is at risk for this infection?
Patients that are at highest risk for endocarditis are children with congenital heart defects that cause them to be “blue” or have lower oxygen levels (cyanotic heart defects), patients with prosthetic heart valves, patients who have had endocarditis in the past, and patients who have had heart surgery in the past 6 months. Patients that do not require SBE prophylaxis include children with acyanotic congenital heart defects (for example - >ASD, VSD, aortic or pulmonary valve stenosis to name a few), and children who have had their hearts surgically repaired over 6 months ago and have been cleared by their cardiologist.
How does SBE prophylaxis protect these patients?
Patients who need SBE prophylaxis will be given a prescription for an antibiotic medication. This is taken 30 minutes to 1 hour before the patient’s dental cleaning or surgical procedure. The antibiotic helps protect the bloodstream and the heart from becoming infected by any bacteria that may be released into the blood during the procedure. The dose of antibiotic is usually much larger than what is given for a typical infection, but only needs to be taken 1 time prior to the procedure.
What should I do if I think my child may need SBE prophylaxis?
If your child has a history of a heart defect and you are not sure whether or not they need SBE prophylaxis, speak to your cardiologist several days before any procedure your child is having to find out if medication may be required. If needed, your cardiologist will call in a prescription for you with instructions on when to give the medicine to your child. In addition, some dentists and doctors will request a letter stating whether or not SBE prophylaxis is necessary. This can be provided to you or your doctor as needed. Finally, the American Heart Association provides wallet cards with specific guidelines including medication recommendations, found here: SBE prophylaxis cards.
Don’t hesitate to call your cardiologist with any questions or concerns regarding your child’s heart history and risk for infection. We are here to help protect your child and their heart!
Christy Glasow, M.D.
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