Endocarditis Prophylaxis

There have been significant changes in the recommendations for endocarditis prophylaxis by the AHA in 2007 given that bacteraemia resulting from daily activities is thought to be much more likely to cause infective endocarditis than bacteraemia associated with dental procedures. Only a very small number of cases of endocarditis might be prevented by antibiotic prophylaxis even if prophylaxis is 100% effective. Therefore only those cardiac conditions associated with the highest risk of adverse outcome from endocarditis are recommended for prophylaxis with dental procedures.

1. Prosthetic cardiac valves
   
   
2. Previous infective endocarditis
   
   
3. Congenital heart disease (Unrepaired cyanotic congenital heart disease including palliative shunts and conduits. Completely repaired congenital heart defect with prosthetic material during the first 6 months after the procedure. Repaired congenital heart disease with residual defects)
   
   
4. Cardiac transplantation recipients who develop cardiac valvulopathy

Antibiotic prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissues or periapical region of teeth or perforation of oral mucosa only for those patients as above.

Antibiotic prophylaxis is recommended for procedures on respiratory tract or infected skin or musculoskeletal tissue only for the above patients.

Antibiotic prophylaxis solely to prevent endocarditis is not recommended for gastrointestinal or genitourinary tract procedures.

Preventative Regimens

Dental, oral or respiratory procedures:

Standard – oral

• Amoxicillin 2.0 g orally 1 hour before procedure

Standard parenteral

• Ampicillin 2.0 g IM or IV within 30 minutes before procedure

Allergic to Penicillin – oral

• Clindamycin 600mg orally 1hour before procedure
• Cephalexin 2.0g orally 1 hour before procedure
• Azithromycin or Clarithromycin 500mg orally 1 hour before procedure

Allergic to Penicillin – parenteral

• Clindamycin 600mg IV within 30 minutes before procedure or Cefazolin/Ceftriaxone 1.0 g IM or IV within 30 minutes before procedure (avoid Cefazolin/Ceftriaxone for patients with immediate-type allergic reaction to Penicillin)