Endocarditis prophylaxis regimens for dental procedures
Antibiotic prophylaxis regimens
If a patient is having more than one procedure requiring antibiotic prophylaxis, the dentist should plan the treatment so that all procedures can be completed in a single sitting, or at most two sittings, to avoid the need for multiple antibiotic doses.
For endocarditis prophylaxis, use:
amoxicillin 2 g (child: 50 mg/kg up to 2 g) orally, 60 minutes before the procedure. endocarditis prophylaxis, dental procedures amoxicillin amoxicillin amoxicillin
If oral administration is not possible, use:
1 amoxicillin 2 g (child: 50 mg/kg up to 2 g) intramuscularly, 30 minutes before the procedure amoxicillin amoxicillin amoxicillin
OR
1 amoxicillin 2 g (child: 50 mg/kg up to 2 g) intravenously, within the 60 minutes before the procedure amoxicillin amoxicillin amoxicillin
OR
1 ampicillin 2 g (child: 50 mg/kg up to 2 g) intramuscularly, 30 minutes before the procedure endocarditis prophylaxis, dental procedures ampicillin
OR
1 ampicillin 2 g (child: 50 mg/kg up to 2 g) intravenously, within the 60 minutes before the procedure. ampicillin
For patients with delayed nonsevere hypersensitivity to penicillins, cefalexin can be used in most cases1. Use:
cefalexin 2 g (child: 50 mg/kg up to 2 g) orally, 60 minutes before the procedure. endocarditis prophylaxis, dental procedures cefalexin
If oral administration is not possible, use:
1 cefazolin 2 g (child: 30 mg/kg up to 2 g) intramuscularly, 30 minutes before the procedure endocarditis prophylaxis, dental procedures cefazolin
OR
1 cefazolin 2 g (child: 30 mg/kg up to 2 g) intravenously, within the 60 minutes before the procedure. cefazolin
For patients with immediate (severe or nonsevere) or delayed severe hypersensitivity to penicillins, use:
clindamycin 600 mg (child: 20 mg/kg up to 600 mg) orally, 60 to 120 minutes before the procedure2. endocarditis prophylaxis, dental procedures clindamycin
If oral administration is not possible, use:
clindamycin 600 mg (child: 20 mg/kg up to 600 mg) intravenously, within the 120 minutes before the procedure. clindamycin
There is some evidence that moxifloxacin may be used as an alternative to clindamycin for patients with immediate (severe or nonsevere) or delayed severe hypersensitivity to penicillins, but this has not been validated.
Considerations for patients recently or currently taking beta lactams
In patients taking long-term benzathine benzylpenicillin for prevention of recurrent rheumatic fever, evidence suggests that the amoxicillin susceptibility of viridans streptococci in the oral flora is not significantly affected by the benzathine benzylpenicillin prophylaxis. The consensus view of the Antibiotic Expert Groups is that amoxicillin is appropriate for endocarditis prophylaxis in this setting.
In contrast, in patients currently taking or who have recently taken a course of beta-lactam therapy (except for the situation described above), evidence suggests that the amoxicillin susceptibility of viridans streptococci may be affected. Therefore, a non–beta-lactam antibiotic, such as clindamycin, may be considered for prophylaxis in this setting.