Prophylaxis is not required for flexible bronchoscopy, endotracheal intubation, or cardiac catheterization. No second dose is necessary. For details or more information, please see complete article which follows. Early recommendations gave antibiotics for two days before the procedure, but this tended to select for resistant organisms.
Current recommendation is for administration as a single dose just before the instrumentation.
All those with valvar abnormalities, whether congenital, rheumatic, or with prosthetic valve in place. Mitral valve prolapse is an area of debate with many recommending NO propylaxis in the absence of an audible murmur. Patients with ASD either pre-repair or after repair are NOT at increased risk of endocarditis. Children after repair of VSD and PDA who have no murmur are no longer at increased risk for endocarditis. Cardiac catheterization has been shown NOT to be associated with endocarditis, despite the vascular invasion and manipulation.