Bacterial Endocarditis Prophylaxis
for Dental, Oral, Respiratory Tract or Esophageal Procedures
    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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