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Endocarditis Prophylaxis

Endocarditis prophylaxis is essential to reducing the risk of seeding an abnormal cardiac valve, other abnormal tissue, or hardware during procedures that can be associated with transient bacteremia.

The following recommendations for bacterial endocarditis prophylaxis are adapted from the 2007 American Heart Association Guideline, Prevention of Infective Endocarditis [Wilson: 2007]. A downloadable wallet-sized card describing prophylaxis recommendations is also available at the American Heart Association website Endocarditis Prophylaxis Wallet Care (AHA) .

Dental Procedures

Prescribing patients antibiotics prior to a dental procedure is recommended only for patients with the highest risk of adverse outcomes resulting from bacterial endocarditis (BE). The importance of good oral and dental health and regular visits to the dentist for patients at risk of BE should be emphasized. Antibiotic prophylaxis with dental procedures is recommended only for patients with cardiac conditions associated with the highest risk of adverse outcomes from endocarditis, including:
  • Prosthetic cardiac valve
  • Previous endocarditis
  • Congenital heart disease only in the following categories:
    • Unrepaired cyanotic congenital heart disease, including those with palliative shunts and conduits
    • Completely repaired congenital heart disease with prosthetic material or device, whether placed by surgery or catherter intervention, during the first 6 months after the procedure (as endothelialization of prosthetic material occurs within six months after the procedure)
    • Repaired congenital heart disease with residual defects at the site or adjacent ot the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
    • Cardiac transplantation recipients with cardiac valvular disease

Prophylaxis is recommended in patients with cardiac conditions listed above for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth, or perforation of the oral mucosa.
Antibiotic prophylaxis is NOT recommended for the following dental procedures or events: routine anesthetic injections through noninfected tissue; taking dental radiographs; placement of removable prosthodontic or orthodontic appliances; adjustment of orthodontic appliances; placement of orthodontic brackets; and shedding of deciduous teeth and bleeding from trauma to the lips or oral mucosa.

Antibiotic Prophylactic Regimens Recommended for Dental Procedures: A single dose is given 30-60 minutes before a procedure.
  • For patients able to take oral medication: amoxicillin (2 grams for adults, 50 mg/kg for children)
  • For patients allergic to penicillins but able to take oral medication: cephalexin* (2 grams for adults, 50 mg/kg for children) OR clindamycin (600 mg for adults, 20 mg/kg for children) OR azithromycin or clarithromycin (500 mg for adults, 15 mg/kg for children)
  • For patients unable to take oral medication: ampicillin (2 grams IM or IV for adults, 50 mg/kg IM or IV for children) OR cefazolin or ceftriaxone (1 gram IM or IV for adults, 50 mg/kg IM or IV for children)
  • For patients allergic to penicillins and unable to take oral medications: cefazolin or ceftriaxone (1 gram IM or IV for adults, 50 mg/kg IM or IV for children) OR clindamycin (600 mg IM or IV for adults, 20 mg/kg IM or IV for children)
*Or other first or second generation oral cephalosporin in equivalent adult or pediatric dosage.
Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema or urticaria with penicillins or ampicillin.

Gastrointestinal/Genitourinary Procedures: Antibiotic prophylaxis solely to prevent BE is no longer recommended for patients who undergo a GI or GU tract procedure, including patients with the highest risk of adverse outcomes due to BE.

Other Procedures: BE prophylaxis for procedures of the respiratory tract or infected skin, tissues just under the skin, or musculoskeletal tissue is recommended ONLY for patients with the underlying cardiac conditions shown above.

Resources

Practice Guidelines

The following practice guidelines for the prevention of infectious endocarditis were developed by the American Heart Association and published in 2007.

Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT.
Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group.
Circulation. 2007;116(15):1736-54. PubMed abstract / Full Text

Authors

Compiler: Information compiled by Medical Home Portal authors and staff
Content Last Updated: 12/2009

Page Bibliography

Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT.
Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group.
Circulation. 2007;116(15):1736-54. PubMed abstract / Full Text