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Antibiotic prophylaxis is recommended by the
American Heart Association (AHA) only for patients with cardiac conditions
associated with the highest risk of adverse outcomes from endocarditis,
- Prosthetic cardiac valve or prosthetic material used for cardiac, valve repair
- Previous infective endocarditis
- Unrepaired cyanotic congenital heart disease (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
- Repaired CHD 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
Antibiotic prophylaxis is recommended by the AHA for people with the
above conditions undergoing certain procedures:
All dental procedures that involve manipulation of
gingival tissue or the periapical region of teeth, or perforation of the oral
Antibiotic prophylaxis is NOT recommended for :
Anesthetic injections through noninfected 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.
AHA-Recommended Antibiotic Regimens for a Dental Procedure:
30 to 60 min before procedure give as a single dose:
IF UNABLE TO TAKE ORAL MEDICATIONS
ALLERGIC TO PENICILLIN OR AMOXICILLIN
Cephalexin* 2 grams orally OR
Clindamycin 600 mg orally OR
Azithromycin or clarithromycin 500 mg orally OR
IF ALLERGIC TO PENICILLIN OR AMOXICILLIN AND UNABLE
TO TAKE ORAL MEDICATIONS
If the dosage of antibiotic is inadvertently not administered before the procedure, the dosage may be administered up to 2 hours after the procedure.
*Cephalosporins should not be used in an individual with a
history of anaphylaxis, angioedema, or urticaria with penicillins or ampicillin.
- Invasive procedures of the respiratory tract that involves incision and biopsy
of the respiratory mucosa, such as tonsillectomy or adenoidectomy.
Antibiotic prophylaxis with a regimen as listed for dental procedures is recommended.
Antibiotic prophylaxis is NOT recommended for : bronchoscopy unless it involves incision of the respiratory
Procedures Skin, Skin Structure, or Musculoskeletal
- For patients undergoing a surgical procedure that involves infected skin, skin structure, or
musculoskeletal tissue, it may be reasonable that the antibiotic regimen for treatment of the infection contain
an agent active against staphylococci and ß-hemolytic streptococci, such
as an antistaphylococcal penicillin or a cephalosporin. Vancomycin or clindamycin may be
administered to patients unable to tolerate a ß-lactam or who are
known or suspected to have an infection caused by a methicillin-resistant
strain of staphylococcus.
GI and GU Procedures
Wilson W, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from
the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki
Disease Committee, Council on Cardiovascular Disease in the Young, and the
Council on Clinical Cardiology, Council on Cardiovascular Surgery and
Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary
Working Group [published erratum appears in Circulation 2007;116:e376-7].
Circulation 2007;116:1736–54.PMID: 17446442