Pulmonary Arteriovenous Malformation (PAVM) Medication

Updated: Feb 11, 2021
  • Author: Barry A Love, MD; Chief Editor: Howard S Weber, MD, FSCAI  more...
  • Print
Medication

Medication Summary

Drug therapy is not currently a component of the standard of care for pulmonary arteriovenous malformations (PAVMs).

Patients with pulmonary arteriovenous malformations should be given antibiotic prophylaxis before dental and surgical procedures to prevent seeding of the pulmonary arteriovenous malformation and the subsequent development of a cerebral abscess. [24] The recommended prophylactic regimen includes one of the following:

  • Amoxicillin 3 g orally (PO) 1 hour or 2 g intravenously (IV) 30 minutes before the procedure, followed by 1.5 g PO/IV hours after the initial dose.

  • For patients who are allergic to penicillin, erythromycin 1000 mg PO 2 hours before the procedure, followed by 500 mg PO 6 hours after the initial dose.

  • For patients who are allergic to penicillin, clindamycin 300 mg PO 1 hour or 300 mg IV 30 minutes before procedure, followed by 150 mg PO/IV 6 hours after initial dose.

The recommended prophylactic regimen for genitourinary and GI procedures includes one of the following:

  • Amoxicillin 3 g PO 1 hour before the procedure, followed by 1.5 g PO 6 hours after the initial dose, plus gentamicin 1.5 mg/kg IV 1 hour before the procedure; this may be repeated 8 hours after the initial dose.

  • For patients who are allergic to penicillin, vancomycin 1 g IV over 1 hour plus gentamicin 1.5 mg/kg IV 1 hour before the procedure; this may be repeated 8 hours after the initial dose.

Next:

Antibiotics, prophylactic

Class Summary

Antibiotic prophylaxis is given to patients before performing procedures that may cause bacteremia.

Amoxicillin (Amoxil, Trimox)

Interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria. Used as prophylaxis in minor procedures.

Ampicillin (Marcillin, Omnipen)

For prophylaxis in patients undergoing dental, PO, or respiratory tract procedures. Coadministered with gentamicin for prophylaxis in GI or GU procedures.

Clindamycin (Cleocin)

Used in penicillin-allergic patients undergoing dental, PO, or respiratory tract procedures. Useful for treatment against streptococcal and most staphylococcal infections.

Gentamicin (Garamycin)

Aminoglycoside antibiotic for gram-negative coverage. Used in combination with both an agent against gram-positive organisms and one that covers anaerobes. Used in conjunction with ampicillin or vancomycin for prophylaxis in GI or GU procedures.

Vancomycin (Vancocin)

Potent antibiotic directed against gram-positive organisms and active against Enterococcus species. Useful in the treatment of septicemia and skin structure infections. Indicated for patients who cannot receive or have failed to respond to penicillins and cephalosporins or have infections with resistant staphylococci. Use creatinine clearance to adjust dose in renal impairment. Used in conjunction with gentamicin for prophylaxis in penicillin-allergic patients undergoing GI or GU procedures.

Erythromycin base (EES, E-Mycin, Eryc)

Used for prophylaxis in penicillin-allergic patients undergoing dental, PO, or respiratory tract procedures.

Cefazolin (Ancef)

First-generation semisynthetic cephalosporin that arrests bacterial cell wall synthesis, inhibiting bacterial growth. Primarily active against skin flora, including Staphylococcus aureus.

Cephalexin (Keflex)

First-generation cephalosporin that arrests bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal activity against rapidly growing organisms. Primary activity against skin flora and used for skin infections or prophylaxis in minor procedures.

Cefadroxil (Duricef)

First-generation cephalosporin arrests bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal activity against rapidly growing organisms. Primary activity against skin flora and used for skin infections or prophylaxis in minor procedures.

Azithromycin (Zithromax)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Clarithromycin (Biaxin)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Previous