A 55-year-old man comes to the physician complaining of an episode of rectal bleeding. His past medical history includes chronic constipation for which he takes over-the-counter laxatives. He also has a history of intravenous drug use and an episode of tricuspid and mitral valve infective endocarditis 15 years ago. Since that episode, he has stopped using illicit drugs. The patient has a 20-pack-year smoking history and drinks 1-2 cans of beer daily. Family history is not significant. He is allergic to penicillin.
His vital signs are within normal limits. Physical examination shows no abnormalities. Stool is positive for occult blood.
The patient is scheduled for a colonoscopy.
Which of the following is the most appropriate next step in management?

Question

A 55-year-old man comes to the physician complaining of an episode of rectal bleeding.  His past medical history includes chronic constipation for which he takes over-the-counter laxatives.  He also has a history of intravenous drug use and an episode of tricuspid and mitral valve infective endocarditis 15 years ago.  Since that episode, he has stopped using illicit drugs.  The patient has a 20-pack-year smoking history and drinks 1-2 cans of beer daily.  Family history is not significant.  He is allergic to penicillin.
His vital signs are within normal limits.  Physical examination shows no abnormalities.  Stool is positive for occult blood.
The patient is scheduled for a colonoscopy.
Which of the following is the most appropriate next step in management?

Quizplus · Accepted Answer

11ec193a_9750_1cc1_853d_abfd39c87a79_MD0002_00 The American Heart Association guidelines for the prevention of bacterial endocarditis do not recommend routine antibiotic prophylaxis prior to GI endoscopy. This is true even in patients with a history of endocarditis or valve replacement (table). Thus, this patient can proceed with colonoscopy without antibiotics or further studies (Choices A, B, C, and E). However, patients with ongoing GI or GU infections need prophylactic antibiotics prior to certain procedures. Antibiotics are also recommended before GI procedures for conditions such as cirrhosis and variceal bleeding (even without endoscopy), biliary obstruction and cholangitis, pancreatic cyst, and percutaneous gastrostomy tube placement. Educational objective: Antibiotic prophylaxis is not recommended for patients with mechanical heart valves or prior endocarditis undergoing low-risk procedures such as endoscopy or vaginal/cesarean delivery. Patients undergoing high- risk procedures should receive amoxicillin or clindamycin 30-60 minutes prior to the procedure. __________ References: Current indications for infective endocarditis antibiotic prophylaxis (http://www.ncbi.nlm.nih.gov/pubmed/20218953)

A 55-Year-Old Man Comes to the Physician Complaining of an Episode