Prophylactic Regimens for Bacterial Endocarditis for Dental Procedures

Situation

Agent

Regimen*

Standard general prophylaxis

Unable to take oral medications

Allergic to penicillin and unable to take oral medications

Amoxicillin

Ampicillin

Allergic to penicillin Clindamycin

Cephalexin** or Cefadroxil**

Azithromycin or Clarithromycin

Clindamycin

Cefazolin*

Adults: 2 g orally 1 hr prior to procedure Children: 50 mg/kg orally 1 hr prior to procedure

Adults: 2 g IM or IV within 30 min of starting the procedure

Children: 50 mg/kg IM or IV within minutes of starting the procedure

Adults: 600 mg orally 1 hr prior to procedure Children: 20 mg/kg orally 1 hr prior to procedure Adults: 2 g orally 1 hr prior to procedure Children: 50 mg/kg orally 1 hr prior to procedure Adults: 500 mg orally 1 hr prior to procedure Children: 15 mg/kg orally 1 hr prior to procedure

Adults: 600 mg IV within 30 min of starting the procedure

Children: 20 mg/kg IV

within 30 min of starting the procedure

Adults: 1 g IM or IV within

30 min of starting the procedure

Children: 25 mg/kg IM or IV within 30 min of starting the procedure

'Children's dose should not exceed adult dose.

"Cephalosporins should not be used in those with immediate type (anaphylaxis) hypersensitivity reactions to penicillins.

PROPHYLACTIC REGIMENS 453

Antibiotic Prophylaxis Is Recommended for the Following Cardiovascular Conditions:

• Prosthetic Cardiac Valves*

• Previous Bacterial Endocarditis*

• Complex Cyanotic Congenital Heart Disease*

• Surgically Constructed Systemic Pulmonary Shunts or Conduits*

• Most other Congenital Cardiac Malformations (other than those listed)f

• Acquired Valvar Dysfunctionf

• Hypertrophic Cardiomyopathy^

• Mitral Valve Prolapse with Valvar Regurgitation or thickened leaflets

• = High risk for endocarditis; f = Moderate risk for endocarditis Dental Procedures

• Dental Extractions

• Periodontal Procedures (surgery, scaling and root planing, probing, recall maintenance)

• Dental Implant Replacement and Reimplantation of Avulsed Teeth

• Endodontic Instrumentation or Surgery only Beyond the Apex

• Subgingival Placement of Antibiotic Fibers or Strips

• Initial Placement of Orthodontic Bands but not Brackets

• Intraligamentary Local Anesthetic Injections

• Prophylactic Cleaning of Teeth or Implants when Bleeding is Anticipated

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