| Antibiotic regimens for endocarditis prophylaxis | ||
| |
Dental, Oral, Respiratory Tract, or Esophageal Procedures | |
| SITUATION | ADULT REGIMEN | CHILDREN'S REGIMEN (Total children's dose should not exceed adult dose) |
| Standard general prophylaxis | Amoxicillin 2 g 1 h before procedure | Amoxicillin 50 mg/kg orally 1 h before procedure |
| Unable to take oral meds | Ampicillin 2 g I.M./I.V. within 30 min before procedure | Ampicillin 50 mg/kg I.M./I.V. within 30 min before procedure |
| Allergic to penicillin | Clindamycin 600 mg 1 h before procedure --or-- Cephalexin or cefadroxil 2 g 1 h before procedure --or-- Azithromycin or clarithromycin 500 mg 1 h before procedure |
Clindamycin 20 mg/kg orally 1 h before procedure --or-- Cephalexin or cefadroxil 50 mg/kg orally 1 h before procedure --or-- Azithromycin or clarithromycin 15 mg/kg orally 1 h before procedure |
| Unable to take oral meds and allergic to penicillin | Clindamycin 600 mg IV within 30 min before procedure --or-- Cefazolin 1 g IV/IM within 30 min before procedure |
Clindamycin 20 mg/kg IV within 30 min before procedure --or-- Cefazolin 25 mg/kg IV/IM within 30 min before procedure |
| -- | -- | -- |
| |
Genitourinary/Gastrointestinal (Excluding Esophageal) Procedures | |
| SITUATION | ADULT REGIMEN | CHILDREN'S REGIMEN (Total children's dose should not exceed adult dose) |
| High Risk Patients | Ampicillin 2 g I.M. or I.V. plus gentamicin 1.5 mg/kg (not to exceed 120 mg) within 30 min of starting the procedure; 6 h later, ampicillin 1 g I.M./I.V. or amoxicillin 1 g orally | Ampicillin 50 mg/kg I.M./I.V. (not to exceed 2 g) plus gentamicin 1.5 mg/kg within 30 min of starting the procedure; 6 h later, ampicillin 25 mg/kg I.M./I.V. or amoxicillin 25 mg/kg orally |
| High-risk patients allergic to ampicillin/amoxicillin | Vancomycin 1 g I.V. over 1-2 h plus gentamicin 1.5 mg/kg I.M./I.V. (not to exceed 120 mg); complete injection/infusion within 30 min of starting the procedure | Vancomycin 20 mg/kg I.V. over 1-2 h plus gentamicin 1.5 mg/kg I.M./I.V.; complete injection/infusion within 30 min of starting the procedure |
| Moderate Risk Patients | Amoxicillin 2 g orally 1 h before procedure, or ampicillin 2 g I.M./I.V within 30 min of starting the procedure | Amoxicillin 50 mg/kg orally 1 h before procedure, or ampicillin 50 mg/kg I.M./I.V. within 30 min of starting the procedure |
| Moderate-risk patients allergic to ampicillin/amoxicillin | Vancomycin 1 g I.V. over 1-2 h; complete infusion within 30 min of starting the procedure | Vancomycin 20 mg/kg I.V. over 1-2 h; complete infusion within 30 min of starting the procedure |
| Risk of Endocarditis for Cardiac Conditions | ||
| HIGH RISK (PROPHYLAXIS RECOMMENDED) | MEDIUM RISK (PROPHYLAXIS RECOMMENDED) | NEGLIGIBLE RISK (PROPHYLAXIS NOT RECOMMENDED) |
| Prosthetic cardiac valves, including bioprosthetic and homograft valves | Most congenital cardiac malformations that are not high or negligible risk | Isolated secundum atrial septal defect |
| Previous bacterial endocarditis | Acquired valvar dysfunction (eg, rheumatic heart disease) | Surgical repair of atrial septal defect, ventricular septal defect, or patent ductus arteriosus (without residua beyond 6 mo) |
| Complex cyanotic congenital heart disease (eg, single ventricle states, transposition of the great arteries, tetralogy of Fallot) | Hypertrophic cardiomyopathy | Previous coronary artery bypass graft surgery |
| Surgically constructed systemic pulmonary shunts or conduits | Mitral valve prolapse with valvar regurgitation and/or thickened leaflets | Mitral valve prolapse without valvar regurgitation |
| -- | -- | Physiologic, functional, or innocent heart murmurs |
| -- | -- | Previous Kawasaki disease without valvar dysfunction |
| -- | -- | Previous rheumatic fever without valvar dysfunction |
| -- | -- | Cardiac pacemakers (intravascular and epicardial) and implanted defibrillators |
| Procedures Requiring Endocarditis Prophylaxis For Patients At Risk For Endocarditis | |
| PROPHYLAXIS RECOMMENDED | PROPHYLAXIS NOT RECOMMENDED |
| Dental extractions | Restorative dentistry (operative and prosthodontic) with or without retraction cord (unless significant bleeding) |
| Periodontal procedures including surgery, scaling and root planing, probing, and recall maintenance | Oral local anesthetic injections (nonintraligamentary) |
| Dental implant placement and reimplantation of avulsed teeth | Intracanal endodontic treatment; post placement and buildup |
| Endodontic (root canal) instrumentation or surgery only beyond the apex | Placement of rubber dams (oral) |
| Subgingival placement of antibiotic fibers or strips | Postoperative oral suture removal |
| Initial placement of orthodontic bands but not brackets | Placement of removable prosthodontic or orthodontic appliances |
| Intraligamentary local anesthetic injections | Taking of oral impressions |
| Prophylactic cleaning of teeth or implants where bleeding is anticipated | Fluoride treatments |
| Tonsillectomy and/or adenoidectomy | Taking of oral radiographs |
| Surgical operations that involve respiratory mucosa | Orthodontic appliance adjustment |
| Bronchoscopy with a rigid bronchoscope | Shedding of primary teeth |
| Sclerotherapy for esophageal varices | Endotracheal intubation |
| Esophageal stricture dilation | Bronchoscopy with a flexible bronchoscope, with or without biopsy |
| Endoscopic retrograde cholangiography with biliary obstruction | Tympanostomy tube insertion |
| Biliary tract surgery | Transesophageal echocardiography |
| Surgical operations that involve intestinal mucosa | Endoscopy with or without gastrointestinal biopsy |
| Prostatic surgery | Vaginal hysterectomy |
| Cystoscopy | Vaginal delivery |
| Urethral dilation | Caesarean section |
| -- | if uninfected: Urethral catheterization |
| -- | if uninfected: Uterine dilatation and curettage |
| -- | if uninfected: Therapeutic abortion |
| -- | if uninfected: Sterilization procedures |
| -- | if uninfected: Insertion or removal of intrauterine devices |
| -- | Cardiac catheterization, including balloon angioplasty |
| -- | Implanted cardiac pacemakers,implanted defibrillators, and coronary stents |
| -- | Incision or biopsy of surgically scrubbed skin |
| -- | Circumcision |
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