Endocarditis Protocol

Antibiotic prophylaxis with dental procedures is recommended only for patients with cardiac conditions associated with the highest risk of adverse outcomes from endocarditis, including:

Prosthetic cardiac valve

Previous endocarditis

Congenital heart disease only in the following categories

Unrepaired cyanotic congenital heart disease, including those with palliative shunts and conduits

Completely repaired congenital heart disease with prosthetic material or device, whether placed by surgery or catheter intervention, during the first six months after the procedure*

Repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)

Cardiac transplantation recipients with cardiac valvular disease

*Prophylaxis is recommended because endothelialization of prosthetic material occurs within six months after the procedure.

Prevention of Prosthetic Joint Infection

In 2014, the ADA Council on Scientific Affairs assembled an expert panel to update and clarify the clinical recommendations found in the 2012 evidence-based guideline, Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures.

As was found in 2012, the 2014 updated systematic review found no association between dental procedures and prosthetic joint infections.  Based on this review, the 2014 Panel concluded that prophylactic antibiotics given prior to dental procedures are not recommended for patients with prosthetic joint implants.

Dental procedures for which prophylaxis is recommended in patients with cardiac conditions listed above:
All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth, or perforation of the oral mucosa*

*Antibiotic prophylaxis is NOT recommended for the following dental procedures or events:
routine anesthetic injections through non infected tissue; taking dental radiographs; placement of removable prosthodontic or orthodontic appliances; adjustment of orthodontic appliances; placement of orthodontic brackets; and shedding of deciduous teeth and bleeding from trauma to the lips or oral mucosa.

Antibiotic Prophylactic Regimens Recommended for Dental Procedures

Situation Agent   Regimen -Single dose 30 –
60 minutes before procedure
    Adult Children
Oral Amoxicillin 2 gm 50 mg/kg
  Ampicillin 2 g IM or IV* 50 mg/kg IM or IV
Unable to take
oral medication
OR    
  Cefazolin or
cefrtiaxone
1 g IM or IV 50 mg/kg IM or IV
Allergic to
penicillins or
ampicillin
Cephalexin**

OR

Clindamycin

2 g

600 mg

50 mg/kg

20 mg/kg

Oral regimen OR    
  Azithromycin or
clarithromycin
500 mg 15 mg/kg
Allergic to
penicillins or
ampicillin and
unable to take
oral medication
Cefazonlin or
ceftriaxone
1 g IM or IV 50 mg/kg IM or IV
  OR    
  Clindamycin 600 mg IM or IV 20 mg/kg IM or IV

*IM intramuscular; IV intravenous

**Or other first or second generation oral cephalosporin in equivalent adult or pediatric dosage.

Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema or urticaria with penicillins or ampicillin.

Gastrointestinal/Genitourinary Procedures: Antibiotic prophylaxis solely to prevent BE is no longer recommended for patients who undergo a GI or GU tract procedure, including patients with the highest risk of adverse outcomes due to BE.

Other Procedures: BE prophylaxis for procedures of the respiratory tract or infected skin, tissues just under the skin, or musculoskeletal tissue is recommended ONLY for patients with the underlying cardiac conditions shown above.

Adapted from Prevention of Infective Endocarditis: Guidelines From the American Heart Association, by the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease. Circulation, e-published April 19, 2007. Accessible at www.americanheart.org/presenter.jhtml?identifier=3004539.

Healthcare Professionals Please refer to these recommendations for more complete information as to which patients and which procedures need prophylaxis.

Information taken from American Heart Association’s website