Infective Endocarditis Prophylaxis

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  • Antibiotic prophylaxis should be considered for patients at highest risk for IE:
  • Patients with any prosthetic valve, including a trans catheter valve, or those in whom any prosthetic material was used for cardiac valve repair
  • Patients with a previous episode of IE
  • Patients with Congenital Heart Disease (CHD):
    • Any type of cyanotic CHD
    • Any type of CHD repaired with a prosthetic material, whether placed surgically or by percutaneous  techniques,  up  to  6  months  after  the  procedure  or  lifelong  if  residual shunt or valvular regurgitation remains

Note: Antibiotic prophylaxis is not recommended in other forms of valvular or CHD. 

Prophylaxis of Endocarditis Infective 

  • To reduce the risk of bacterial endocarditis, antibiotic prophylaxis should be given to patients undergoing dental procedures requiring manipulation of the gingival or periapical region of the teeth or perforation of the oral mucosa.

Antibiotic prophylaxis is not recommended for:

  • Respiratory tract procedures including bronchoscopy or laryngoscopy, or transnasal or endotracheal intubation
  • Gastrointestinal or urogenital procedures or trans–oesophageal echocardiogram, gastroscopy, colonoscopy, cystoscopy, vaginal or caesarean delivery
  • Skin and soft tissue procedures

Table 20.6: Recommended prophylaxis for high–risk dental procedures in high-risk patient 

Situation 

 

Single–dose 30–60 minutes before procedure 

Situation

Antibiotic 

Adults

Children

No allergy to penicillin or 
ampicillin 

amoxicillin or 
ampicillin* 

2g (PO/IV) 

50 mg/kg (PO/IV) 

Allergy to penicillin or ampicillin 

clindamycin 

600 mg (PO/IV) 

20 mg/kg (PO/IV) 

*Alternatively, B: ceftriaxone (IV) 1g for adults or 50 mg/kg for children. Cephalosporins should not be used in patients with anaphylaxis, angio-oedema, or urticaria after intake of penicillin or ampicillin due to cross–sensitivity