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)
    1. Unrepaired cyanotic CHD, including palliative shunts and conduits
    2. 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
    3. 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

*   Total children’s dose should NOT exceed adult dose.

** Cephalosporin antibiotics should not be used in individuals with penicillin-allergy who have the following reactions: urticaria, angioedema, anaphylaxis