Contemporary Approaches to Antibiotic Prophylaxis 2nd Edition
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Table 4
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Special Considerations
•
Patients who are at risk for IE can receive any indicated dental care.
•
Coronary artery bypass graft (CABG) or coronary artery stents (after endothelialization) do not routinely require antibiotic prophylaxis
prior to dental treatment.
•
If the dosage of antibiotic is inadvertently not administered before the procedure, the dosage may be administered up to two hours after
the procedure.
•
If a patient is already receiving chronic antibiotic therapy with an antibiotic that is also recommended for IE prophylaxis, it is prudent to
select an antibiotic from a different class rather than to increase the dosage of the current antibiotic, or preferably delay dental treatment
for 10 days after completion of the antibiotic therapy to allow time for the usual oral flora to be re-established.
Table 3
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Antibiotic regimens for a dental procedure*
Single Dose 30 to 60 min Before Procedure
ADULTS:
Amoxicillin 2 g
CHILDREN:
Oral Amoxicillin 50 mg/kg
ADULTS
unable to take oral medication:
Ampicillin 2 g IM or IV
OR Cefazolin or ceftriaxone 1 g IM or IV
CHILDREN
unable to take oral medication:
Ampicillin 50 mg/kg IM or IV
OR Cefazolin or ceftriaxone 50 mg/kg IM or IV
ADULTS
Allergic to penicillins or ampicillin:
Oral Cephalexin^† 2 g or Clindamycin 600 mg
OR Azithromycin or clarithromycin 500 mg
CHILDREN
Allergic to penicillins or ampicillin:
Oral Cephalexin^† 50 mg/kg or Clindamycin 20 mg/kg
OR Azithromycin or clarithromycin 15 mg/kg
ADULTS
Allergic to penicillins or ampicillin
and unable to take oral medication:
Cefazolin or ceftriaxone† 1 g IM or IV
OR Clindamycin 600 mg IM or IV
CHILDREN
Allergic to penicillins or ampicillin
and unable to take oral medication:
Cefazolin or ceftriaxone† 50 mg/kg IM or IV
OR Clindamycin 20 mg/kg IM or IV
IM: intramuscular
IV: intravenous
^ Or other first or second-generation oral cephalosporin in equivalent adult or pediatric dosage
† Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema, or urticaria with penicillins or ampicillin
*
Adapted from Wilson W, Taubert KA, Gewitz M, et al; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee,
American Heart Association Council on Cardiovascular Disease in the Young, American Heart Association Council on Clinical Cardiology, American Heart
Association Council on Cardiovascular Surgery and Anesthesia, Quality of Care and Outcomes Research Interdisciplinary Working Group. Prevention of
infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association rheumatic Fever, Endocarditis, and
Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery
and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007;116:1736–54