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AHA/ADA recommendations to prevent infective endocarditis (2007)

Dental procedure for which endocarditis prophylaxis is recommended

Antibiotic prophylaxis for infective endocarditis

Prescription for antibiotic prophylaxis for a patient at risk for infective endocarditis. 4 visits

AHA/ADA recommendations to prevent infective endocarditis (2007):

It is reasonable to use endocarditis prophylaxis for the following conditions:

  • Prosthetic cardiac valves.
  • Previous infective 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 6 months after the procedure.
    Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device.
  • Cardiac transplant recipient who developed cardiac valvulopathy.

* Except for conditions listed above, antibiotic prophylaxis is no longer recommended for any form of CHD.

Dental procedure for which endocarditis prophylaxis is recommended:

All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. The following procedures and events do not need prophylaxis:

  • Routine anesthetic injections through noninfected tissue
  • Taking dental radiographs
  • Placement of removable prosthodontic or orthodontic appliances
  • Placement of orthodontic bands
  • Shedding of deciduous teeth
  • Bleeding form the lips or oral mucosa

Antibiotic prophylaxis for infective endocarditis:

Abbreviations:
IM = intramuscular
IV = intravenous

Caution: Cephalosporins should not be administered to patients with a history of anaphylaxis, angioedema or urticaria caused by penicillin or ampicillin.

Adult Regimen:

Situation Agent Adult Regimen
(one dose 30-60 min. before procedure)
Standard general prophylaxis amoxicillin 2 g orally
Unable to take oral medication ampicillin, or 2 g IM or IV
cefazolin or ceftriaxone 1 g IM or IV
Allergic to penicillin clindamycin, or 600 mg orally
cephalexin, or 2 g orally
azithromycin or clarithromycin 500 mg orally
Allergic to penicillin or ampicillin
and unable to take oral medication
clindamycin, or 600 mg IM or IV
cefazolin or ceftriaxone 1 g IM or IV

Pedriatic Regimen:

Situation Agent Pediatric Regimen
(one dose 30-60 min. before procedure)
Standard general prophylaxis amoxicillin 50 mg/kg orally
Unable to take oral medication ampicillin, or 50 mg IM or IV
cefazolin or ceftriaxone 50 mg IM or IV
Allergic to penicillin clindamycin, or 20 mg/kg orally
cephalexin, or 50 mg/kg orally
azithromycin or clarithromycin 15 mg/kg orally
Allergic to penicillin or ampicillin
and unable to take oral medication
clindamycin, or 20 mg/kg IM or IV
cefazolin or ceftriaxone 50 mg/kg IM or IV

Prescription for antibiotic prophylaxis for a patient at risk for infective endocarditis. 4 visits:

Patients with no penicillin or amoxicillin allergies
Date: 1/1/11
Name: John Doe DOB: 1/1/50
Address: 123 Main Street, Pleasantville, PA
Amoxicillin 500 mg tab.
Disp. 16 tabs.
Sig. 4 tabs. po, 30-60 min. prior to dental appointment
Patients with penicillin or amoxicillin allergies
Date: 1/1/11
Name: John Doe DOB: 1/1/50
Address: 123 Main Street, Pleasantville, PA
Clindamycin 300 mg tab.
Disp. 8 tabs.
Sig. 2 tabs. po, 30-60 min. prior to dental appointment

OK