The American Heart Association (AHA) has recently revised its recommendationsregarding endocarditis prophylaxis for patients with heart disease undergoing non-cardiac 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.
Previous angioplasty and stenting, bypass surgery or pacemaker or ICD placement are not recognized indications for antibiotic prophylaxis prior to dental procedures.

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 or clarithromycin 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

Review the guidelines here