Quality Resource Guide l Contemporary Approaches to Antibiotic Prophylaxis 3rd Edition 6 www.metdental.com Table 4 15 - 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 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. • In patients undergoing multiple sequential dental appointments, if possible, it is preferable to delay the next procedure for 10 days after the last dose of antibiotic therapy. • In patients who are receiving parenteral antimicrobial therapy for IE or other infections and require a dental procedure, the same parenteral antibiotic may be continued through the dental procedure. • For all patients with an increased risk of or from VGS IE, a plan for responding to IE symptoms should be reinforced at every health care contact. • Current scientific data suggest that maintaining good oral health care in patients at risk of or from VGS IE has a major impact on preventing bacteremia with VGS from routine daily activities such as toothbrushing * Adapted from Reference 15 Table 3 15 - Antibiotic regimens for a dental procedure* Single Dose 30 to 60 min Before Procedure Situation Agent Adults Children Oral Amoxicillin 2 g 50 mg/kg Unable to take oral medication Ampicillin OR 2g IM or IV 50 mg/kg IM or IV Cefazolin or ceftriaxone 1 g IM or IV 50 mg/kg IM or IV Allergic to penicillin or ampicillin - oral Cephalexin* OR 2 g 50 mg/kg Azithromycin or clarithromycin OR 500 mg 15 mg/kg Doxycycline 100 mg <45 kg, 2.2 mg/kg >45 kg, 100 mg Allergic to penicillin or ampicillin and unable to take oral medication Cefazolin or ceftriaxone† 1 g IM or IV 50 mg/kg IM or IV Clindamycin is no longer recommended for antibiotic prophylaxis for a dental procedure. Macrolide antibiotics should be used with caution in patients who are known to have a prolonged QTc interval. IM indicates intramuscular; and IV, intravenous. * Or other first- or second-generation oral cephalosporin in equivalent adult or pediatric dosing. † Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema, or urticarial with penicillin or ampicillin. * Adapted from Reference 15