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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, including:

  • 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 the procedure
  • 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:

   Dental Procedures

  • 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 : 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:

      Amoxicillin 2 grams orally

    IF UNABLE TO TAKE ORAL MEDICATIONS

      Ampicillin 2grams  IM or IV OR
      Cefazolin* or ceftriaxone* 1 gram IM or  IV 

    IF 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

      Cefazolin* or ceftriaxone* 1 gram IM or  IV  OR
      Clindamycin 600 mg IM or  IV


    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.

    Respiratory Tract

    • 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 tract mucosa

       Procedures Skin, Skin Structure, or Musculoskeletal Tissue

    • 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 -hemolytic streptococci, such as an antistaphylococcal penicillin or a cephalosporin. Vancomycin or clindamycin may be administered to patients unable to tolerate a -lactam or who are known or suspected to have an infection caused by a methicillin-resistant strain of staphylococcus.

       GI and GU Procedures

    • For patients undergoing a procedure that involves infection of the GI or GU tracts  (such as chorioamnionitis or pyleonephritis) it may be reasonable that the antibiotic regimen contain an agent active against enterococci. Amoxicillin or ampicillin is the preferred agent for enterococcal coverage. Vancomycin may be administered to patients unable to tolerate ampicillin. Consultation with an infectious diseases expert is recommended if the infection is caused by a known or suspected strain of resistant enterococcus.

      Antibiotic prophylaxis for endocarditis is NOT recommended for : Vaginal delivery or cesarean section in the absence of infection.


    Reference
    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;116:173654.PMID: 17446442

       

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