Infective Endocarditis Prophylaxis – Guidelines
Guidelines
Infective Endocarditis Prophylaxis
According to a Scientific Statement from the American Heart Association on May 18, 2021, there are no recommended changes to the 2007 viridans group streptococcal (VGS) infective endocarditis (IE) prevention guidelines.
The major change to the 2007 guidelines is the suggested exclusion of clindamycin for antibiotic prophylaxis (AP) as this medication has been associated with more frequent and severe reactions than other antibiotics used for AP.
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 | ||
| cephalexin, or | 2 g orally | |
| azithromycin or clarithromycin | 500 mg orally | |
| Allergic to penicillin or ampicillin and unable to take oral medication |
||
| 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 | ||
| cephalexin, or | 50 mg/kg orally | |
| azithromycin or clarithromycin | 15 mg/kg orally | |
| Allergic to penicillin or ampicillin and unable to take oral medication |
||
| 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: 1/1/22 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: 1/1/22 Name: John Doe DOB: 1/1/50 Address: 123 Main Street, Pleasantville, PA Azithromycin 500 mg tab. Disp. 4 tabs. Sig. 1 tab. po, 30-60 min. prior to dental appointment |
References/Websites
- References
- Websites