The following is a summary of the 2007 American Heart Association revision for recommendations for endocarditis antibiotic prophylaxis.
Endocarditis Antibiotic Prophylaxis IS indicated for the following Cardiac Conditions:
-
Prosthetic cardiac valves or material+
-
Previous, relapse, or recurrent infective endocarditis
-
Congenital heart disease (CHD)*
-
Unprepared 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 effects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibits endothelialization).
-
Cardiac transplantation recipients who develop cardiac valvulopathy.
+For patients who have a left ventricular assist device (LVAD): a medical consultation is required.
*Except for the conditions listed above, antibiotic prophylaxis is no longer recommended for any other form of CHD.
**Prophylaxis is recommended because endothelialization of prosthetic material occurs within six months after the procedure.
Dental Procedures Where Endocarditis Prophylaxis IS indicated:
All dental procedures which involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa*.
(See Table below)
Dental Procedures That Do Not Require Endocarditis Prophylaxis:
*The following procedures and events do not need prophylaxis:
-
Routine anesthetic injections through non-infected tissue
-
Taking dental radiography
-
Placement of removable prosthodontics or orthodontic appliances
-
Adjustment of orthodontic appliances
-
Placement of orthodontic brackets
-
Shedding of primary teeth
-
Bleeding from trauma to the lips or oral mucosa.
Antibiotic Regimens for Endocarditis Prophylaxis
Regimen: Single Dose 30 - 60 minutes Before Procedure
|
|
Situation
|
Agent
|
Adults
|
Children
|
|
Oral
|
Amoxicillin
|
2 grams
|
50 milligrams/
kilogram
|
|
Unable to take Oral Medication
|
Ampicillin
OR
Cefazolin or Ceftriaxone§
|
2 g IM or IV
1g IM or IV
|
50 mg/kg IM or IV
50 mg/ kg IM or IV
|
|
Allergic to Penicillin or Ampicillin - Oral
|
Cephalexin‡
OR
Azithromycin or
Clarithromycin
OR
Doxycycline€
|
2g
500mg
100mg
|
50 mg/ kg
15 mg/ kg
<45kg, 2.2 mg/kg
>45kg, 100mg
|
|
Allergic to Penicillin or Ampicillin and unable to take oral medication
|
Cefazolin or Ceftriaxone§
|
1 g IM or IV
|
50 mg/ kg IM or IV
|
|
Clindamycin is no longer recommended for antibiotic prophylaxis for a dental procedure.
IM: Intramuscular
IV: Intravenous
‡ Or other first- or second-generation oral cephalosporin in equivalent adult or pediatric dosage
§ Cephalosporins should not be used in a person with a history of anaphylaxis, angioedema, urticaria, or ampicillin.
€ Not recommended for children < 8 years old
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