Skip to main content

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:

SituationAgentAdult Regimen
(one dose 30-60 min. before procedure)
Standard general prophylaxisamoxicillin2 g orally
Unable to take oral medicationampicillin, or2 g IM or IV
cefazolin or ceftriaxone1 g IM or IV
Allergic to penicillin
cephalexin, or2 g orally
azithromycin or clarithromycin500 mg orally
Allergic to penicillin or ampicillin
and unable to take oral medication
cefazolin or ceftriaxone1 g IM or IV

Pedriatic Regimen:

SituationAgentPediatric Regimen
(one dose 30-60 min. before procedure)
Standard general prophylaxisamoxicillin50 mg/kg orally
Unable to take oral medicationampicillin, or50 mg IM or IV
cefazolin or ceftriaxone50 mg IM or IV
Allergic to penicillin
cephalexin, or50 mg/kg orally
azithromycin or clarithromycin15 mg/kg orally
Allergic to penicillin or ampicillin
and unable to take oral medication
cefazolin or ceftriaxone50 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: 1/1/21
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: 1/1/21
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#