Chemoprophylaxis for Endocarditis

Dental Surgery

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Individuals at high risk should receive prophylactic treatment in cases involving:

  • Prosthetic heart valves (of all types)
  • History of previous bacterial endocarditis
  • Complex cyanotic congenital heart diseases (e.g., Tetralogy of Fallot, transposition of the great arteries)
  • Pulmonary shunts or surgically created communications
  • Pacemakers or implanted defibrillators

A lower risk is observed in:

  • All other congenital heart abnormalities
  • Acquired valvular disease (e.g., rheumatic valvular disease)
  • Hypertrophic cardiomyopathy
  • Mitral valve prolapse with regurgitation and/or leaflet thickening

In other conditions, prophylactic chemoprophylaxis is not mandatory, including:

  • Simple atrial septal defect (ostium secundum)
  • Atrial septal defect, ventricular septal defect, or patent ductus arteriosus, after 6 months of successful surgical correction
  • History of coronary artery bypass graft surgery (CABG)
  • Functional or “innocent” heart murmurs
  • History of rheumatic fever without valvular disease
  • History of Kawasaki disease without valvular disease

Surgical Procedures Requiring Prophylactic Chemoprophylaxis to Prevent Endocarditis

  • Dental procedures such as tooth extractions, periodontitis treatment, implants, endodontic procedures, intraligamentary injections, initial placement of orthodontic bands, and cleanings where bleeding is expected.

Chemoprophylaxis for Endocarditis in Procedures Involving the Oral, Respiratory, and Upper Gastrointestinal Tract

General Guidelines

  • Amoxicillin: 2 g orally, 1 hour before the procedure

If Oral Administration Is Not Possible:

  • Ampicillin: 2 g intramuscularly/intravenously, within 30 minutes before the procedure

For Patients Allergic to Penicillin:

  • Clindamycin: 600 mg orally, 1 hour before the procedure
  • Clarithromycin: 500 mg orally, 1 hour before the procedure

For Patients Allergic to Penicillin and Unable to Take Oral Medication:

  • Clindamycin: 600 mg intravenously, within 30 minutes before the procedure
  • Vancomycin: 1 g intravenously, within 30 minutes before the procedure

Recommended Prophylactic Antibiotic Regimen for Dental Procedures

SINGLE DOSE 30-60 MINUTES BEFORE THE PROCEDURE

Antibiotic Therapy:

Antibiotic Adults Children
Amoxicillin or Ampicillin 2 g orally or IV 50 mg/kg body weight
Clindamycin (for penicillin-allergic patients) 600 mg orally or IV 20 mg/kg orally or IV

Cephalosporins are not recommended for patients with penicillin allergy due to the potential risk of cross-reactivity.