Quality Resource Guide

Management of Patients with Cardiovascular Conditions 5th Edition

www.metdental.com

Because arterial stents are rapidy covered with

endothelium, antibiotic prophylaxis is not typically

recommended after 30 days after stent placement.

It is highly recommended that the dentist contact

the patient’s physician before initiating dental care

for patients with arterial stents.

Antibiotic Prophylaxis

Patients with recently-placed prosthetic joints,

indwelling catheters, artificial vascular grafts,

mechanical heart valves, previous history of

infective endocarditis or congenital heart disease

will typically require antibiotic prophylaxis for dental

procedures. The American Heart Association

(AHA) recently revised its recommendations

for antibiotic prophylaxis during invasive dental

procedures. According to the current AHA

recommendations, cardiac conditions that require

antiobiotic prophylaxis are listed in

Table 2

invasive dental procedures that should be covered

with prophylactic antibiotics are listed in

Table 3

and the recommended antibiotic prophylactic

regimens are listed in

Table 4.

8,9

Patients

with prosthetic joint replacements may require

antibiotic prophylaxis for a period of two years

after the prosthesis is placed (See

Table 5

) and

the recommended antibiotic prophylaxis regimens

are listed in

Table 6.

Selection of antibiotics

should consider whether contraceptives are in

use and the potential for antibiotics to render

the contraceptive agent ineffective (tetracycline

antibiotics). Antibiotic prophylaxis is required for

longstanding indwelling vascular catheters only

during the time that the catheter is in place.

Consultation with the patient’s physician is highly

desirable when considering antibiotic prophylaxis

for any of the conditions listed above.

Table 5 - Guidelines for Prevention of Infection of Total Joint Replacements

Patients at Potential Increased Risk of Experiencing Hematogenous Total Joint Infection

All patients during first two years following joint replacement

II.

Immunocompromised/immunosuppressed patients

Inflammatory arthropathies such as rheumatoid arthritis or systemic lupus erythematosus

Drug- or radiation-induced immunosuppression

III.

Patients with other comorbidities

Previous prosthetic joint infections

Malnourishment

Hemophilia

HIV infection

Insulin-dependent (type I) diabetics

Malignancy

** Dental procedures requiring antibiotic prophylaxis are the same as those listed in Table 3.

JADA, 134:895-899, 2003.

Table 6 - Suggested Antibiotic Prophylaxis

Regimens for Joint Infection Prophylaxis

Patients not allergic to penicillin: Cephalexin, Cephradine or Amoxicillin

2.0 g orally 1 h before procedure

Patients not allergic to penicillin and unable to take oral medications:

Cefazolin or Ampicillin

Cefazolin (1.0 g) or Ampicillin (2 g) IM or IV 1 h before procedure

Patients allergic to penicillin: Clindamycin

600 mg orally 1 h before procedure

Patients allergic to penicillin and unable to take oral medications: Clindamycin

600 mg IV 1 h before procedure

* No second doses are recommended

JADA, 134:895-899, 2003.