Table of Contents
Which procedures may need prophylaxis to prevent infectious endocarditis?
Dental, oral, or upper respiratory tract procedures
Who should receive antibiotic prophylaxis to prevent infectious endocarditis?
People who are at highest risk for infective endocarditis (see below) should take one dose of an antibiotic by mouth (pills or liquid) one hour before certain dental, oral, or upper respiratory tract procedures; a second dose is not necessary.
People with the following conditions are considered to be at the highest risk of developing infectious endocarditis. Preventive antibiotics are generally recommended for people with the following conditions before certain procedures:
- A prosthetic heart valve
- Valve repair with prosthetic material
- A prior history of infectious endocarditis
- Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits
- Completely repaired congenital heart defects with prosthetic material or device during the first six months after the procedure (whether placed by surgery or by catheter intervention)
- Repaired congenital heart disease with residual defects at the site or adjacent to the site of the prosthetic patch or prosthetic device.
What organisms should be empirically covered?
“The organisms that most frequently cause infectious endocarditis include Staphylococcus aureus (31%), Streptococcus viridans (17%), coagulase-negative staphylococci (11%), Enterococcus (11%), Streptococcus bovis (7%), and other streptococci (5%).”
Antibiotics of choice for prophylaxis
Take one dose of an antibiotic by mouth one hour before certain dental, oral, or upper respiratory tract procedures; a second dose is not necessary. Take it 30 minutes before the procedure if it is taken parenterally.
Amoxicillin is the drug of choice for prophylaxis.
Amoxicillin (adults: 2 g; children: 50 mg per kg) taken orally one hour before the procedure x 1 dose.
For patients who can’t take oral medications
Ampicillin (adults: 2 g; children: 50 mg per kg) IM or IV within 30 minutes of the procedure x 1 dose.
Antibiotic Prophylaxis for Patients Allergic to Penicillin
Clindamycin (adults: 600 mg; children: 20 mg per kg) or azithromycin or clarithromycin (adults: 500 mg; children: 15 mg per kg) taken orally one hour before the procedure.
If the patient cannot take oral medications
Clindamycin (adults: 600 mg; children: 20 mg per kg) IV within 30 minutes of the procedure x 1 dose.
If the penicillin allergy was not associated with anaphylaxis, angioedema, or urticaria, the patient may take:
Cephalexin (Keflex; adults: 2 g; children: 50 mg per kg) taken orally x 1 dose, or
Cefazolin (adults: 1 g; children: 50 mg per kg) IM or IV x 1 dose.
Reference / Further Reading
http://www.uptodate.com/contents/antibiotics-before-procedures-beyond-the-basics
Am Fam Physician. 2012 May 15;85(10):981-986. Infectious Endocarditis: Diagnosis and Treatment. https://www.aafp.org/afp/2012/0515/p981.html