Endocarditis Prophylaxis
Antibiotic Regimen for Endocarditis Prophylaxis
All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa.
- Dental extraction
- Periodontal procedures including: surgery, scaling and root planning, probing, subgingival placement of antibiotic fibers/strips
- Dental implant placement
- Reimplantation of avulsed teeth
- Endodontic instrumentation beyond the apex or apical surgery
- Initial placement of orthodontic bands, but not brackets
- Intraligamentary local anesthesia injection
- Prophylactic cleaning of teeth or implants
- Biopsies, suture removal
Cardiac Conditions Requiring Antibiotic Prophylaxis
- Prosthetic cardiac valves, including bioprosthetic and homograft valves
- Previous history of bacterial endocarditis
- Congenital Heart Disease (CHD)
- Unrepaired cyanotic CHD, including palliative shunts and conduits
- Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
- Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
- Cardiac transplantation recipients who develop cardiac valvulopathy
CURRENT AMERICAN HEART ASSOCIATION RECOMMENDATIONS FOR PREVENTION OF BACTERIAL ENDOCARDITIS
Situation | Agent | Regimen* (Single dose 30-60 minutes before procedure) |
---|---|---|
Standard General Prophylaxis | Amoxicillin | Adults: 2.0g PO Children: 50mg/kg PO |
Unable to take oral medication | Ampicillin | Adults: 2.0g IM or IV Children: 50mg/kg IM or IV |
OR | ||
Cefazolin or Ceftriaxone |
Adults: 1g IM or IV Children: 50mg/kg IM or IV |
|
Penicillin-Allergic | Clindamycin | Adults: 600mg PO Children: 20mg/kg PO |
OR | ||
Cephalexin** | Adults: 2.0g PO Children: 50mg/kg PO |
|
OR | ||
Azithromycin or Clarithromycin |
Adults: 500mg PO Children: 15mg/kg PO |
|
Penicillin-Allergic and Unable to take oral Medications |
Clindamycin | Adults: 600mg IV or IM Children: 20mg/kg IV or IM |
OR | ||
Cefazolin** or Ceftraxone |
Adults: 1.0g IM or IV Children: 50mg/kg IM or IV |