CARING FOR THE PEOPLE OF NORTHEAST MICHIGAN
GREAT LAKES HEART CENTER OF ALPENA
PREVENTING INFECTIVE ENDOCARDITIS
The American Heart Association (AHA) has recently revised its recommendations regarding endocarditis prophylaxis for patients with heart disease undergoing dental procedures. The current guidelines recognize that ordinary activities are more likely to cause bacteremia than dental procedures and that only a few cases of endocarditis can be prevented by prophylactic antibiotics. Under current guidelines only the following conditions require prophylactic antibiotics:
- Prosthetic cardiac valve
- Previous IE
- 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. Prophylaxis is recommended because endothelialization of prosthetic
material occurs within 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 who develop cardiac valvulopathy
The recommended antibiotic regimens are:
| Regimen: Single dose 30-60 minutes before procedure | |||
| Situation | Agent | Adult dose | Childrens dose |
| Oral | Ampicillin | 2 g | 50 mg/kg |
| Unable to take oral meds | Ampicillin | 2g IV or IM | 50 mg/kg IV or IM |
| Cefazollin or Ceftriaxone | 1 g IV or IM | 50 mg/kg IV or IM | |
| Penicillin allergic - oral | Cephalexin | 2 g | 50 mg/kg |
| Clindamycin | 600 mg | 20 mg/kg | |
| Azithromycin orclarithromycin | 500 mg | 15 mg/kg | |
| Penicllin allergic and unable to take oral medications | Cefazolin or ceftriaxone | 1 g IV or IM | 50 mg/kg IV or IM |
| Clindamycin | 600 mg | 20 mg/kg | |
| Cephalosporins should not be given to patients with a history of anaphylaxis, angioedema or urticaria with penicillins | |||
Previous angioplasty and stenting, bypass surgery or pacemaker or ICD placement are not recognized indications for antibiotic prophylaxis prior to dental procedures.
Review the new guidelines here
