Bacterial Endocarditis Prophylaxis
for Dental, Oral, Respiratory Tract or Esophageal Procedures
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Standard General Prophylaxis
- Amoxicillin adults 2.0 g; children: 50 mg/kg orally 1 hr before procedure
A follow-up antibiotic dose is no longer recommended.
Unable To Take Oral Medications
- Ampicillin adults 2.0 g; IM or IV; children: 50 mg/kg IM or IV within 30 min before procedure
Allergic To Penicillin
- Clindamycin adults 600 mg; children: 20 mg/kg orally 1 hr before procedure or
- Cephalexin or cefadroxil adults 2.0 g; children 50 mg/kg orally 1 hr before procedure or
- Azithromycin or clarithromycin adults 500 mg; children 50 mg/kg orally 1 hr before procedure
Erythromycin is no longer recommended for penicillin allergic individuals.
Allergic To Penicillin & Unable To Take Oral Medications
- Clindamycin adults 600 mg; children 20 mg/kg IV within 30 min before procedure or
- Cefazolin adults 1.0 g; children 25 mg/kg IM or IV within 30 min before procedure
Endocarditis Prophylaxis Recommended
For These Individuals
High Risk Category
- Prosthetic cardiac valves
- Previous bacterial endocarditis
- Complex cyanotic congenital heart disease
- Surgically constructed systemic pulmonary shunts or conduits
Moderate Risk Category
- Most other congenital cardiac malformations
- Acquired valvar dysfunction (rheumatic heart disease)
- Hypertrophic cardiomyopathy
- Mitral valve prolapse with valvar regurgiation and/or thickened leaflets
Endocarditis Prophylaxis Not Recommended
For These Individuals
Negligible Risk Category (risk no greater than general population)
- Isolated secundum atrial septal defect
- Surgical repair of atrial septal defet, ventricular septal defect, or patent ductus arteriosus (without residua beyond 6 mo)
- Previous coronary artery bypass graft surgery
- Mitral valve prolapse without valvar regurgitation
- Physiologic, functional, or innocent heart murmurs
- Previous Kawasaki disease without valvar dysfunction
- Previous rheumatic fever without valvar dysfunction
- Cardiac pacemakers (intravascular & epicardial) and implanted defibrillators
From: Dajani, A.S., et. al. "Prevention Of Bacterial Endocarditis, Recommendations By The American Heart Association." JAMA 277(22) pp 1794-1801.
Last updated: Aug 14, 1998
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