II. Background: Rationale regarding Guideline changes from 1997 to 2007
- Endocarditis is far more frequent randomly than during dental and other procedures
- Prophylaxis prevents few endocarditis cases
- Risk of adverse events from Antibiotics outweighs benefit of endocarditis prevention
- Optimal Oral Hygiene is key in endocarditis prevention
- Much more important than SBE Antibiotic prophylaxis
III. Indications: Prophylaxis recommended
- Prosthetic Cardiac Valves (biograft and homograft) or prosthetic materials to repair valves
- Previous Bacterial Endocarditis with or without heart disease
- Specific congenital cardiac malformations
- Unrepaired Cyanotic Congenital Heart Disease
- Completely repaired Congenital Heart Disease with prosthetic material in first 6 months
- Partially repaired Congenital Heart Disease with residual defect
- Cardiac Transplantation recipients with cardiac valvulopathy
IV. Indications: Prophylaxis NOT recommended (significant change from prior guidelines)
- Rheumatic and other acquired valve dysfunction
- Hypertrophic Cardiomyopathy
- Mitral Valve Prolapse with valvular regurgitation
- Isolated secundum Atrial Septal Defect (ASD)
- Surgical repair of secundum ASD, VSD, or PDA
- Without residual defect beyond 6 month post-operative period
- Previous Coronary Artery Bypass (CABG)
- Mitral Valve Prolapse without valvular regurgitation
- Physiologic, functional, or innocent Heart Murmurs
- Previous Kawasaki Disease without valve dysfunction
- Cardiac Pacemakers and implanted Defibrillators
V. Indications: Procedures warranting prophylaxis
- Invasive respiratory procedures (e.g. bronchoscopy)
- Dental Procedures
- Gingival or periapical region of teeth manipulated or
- Oral Mucosa perforated
- SBE Prophylaxis NOT indicated in other procedures
- Gastrointestinal and genitourinary procedures do not require SBE Prophylaxis
- Perioperative Antibiotic prophylaxis may be indicated for reasons outside of SBE Prophylaxis
VI. Protocol: General
- Oral prophylaxis given 1 hour before procedure
- IV prophylaxis given 30 minutes before procedure
- Dose after procedure not recommended in 2007 guidelines
VII. Protocol: Adult Prophylaxis: Dental, Oral, Respiratory, Esophageal
- Standard Regimen
- Amoxicillin 2g orally 1 hour before procedure or
- Ampicillin 2g IM/IV 30 minutes before procedure
-
Penicillin Allergic
- Cephalexin OR Cefadroxil 2g orally 1 hour before
- Cefazolin or Ceftriaxone 1.0g IM/IV 30 min before procedure
- Azithromycin or Clarithromycin 500mg orally 1 hour before
- Doxycycline 100 mg 30-60 minutes before procedure
- Clindamycin is NO longer recommended for dental prophylaxis
VIII. Protocol: Child Prophylaxis: Dental, Oral, Respiratory, Esophageal
- Standard Regimen
- Amoxicillin 50 mg/kg (MAX 2g) 1h before procedure
- Ampicillin 50 mg/kg (MAX 2g) IM/IV 30m before
-
Penicillin Allergic
- Cephalexin 50 mg/kg (MAX 2g) PO 1h before or
- Cefadroxil 50 mg/kg (MAX 2g) PO 1h before or
- Cefazolin or Ceftriaxone 50 mg/kg (MAX 1g) IM/IV 30m before
- Azithromycin 15 mg/kg (MAX 500mg) PO 1h before or
- Clarithromycin 15 mg/kg (MAX 500mg) PO
- Doxycycline 2.2 mg/kg (MAX 100 mg) orally 30-60 minutes before procedure (for age >8 years)
- Clindamycin is NO longer recommended for dental prophylaxis
IX. Protocol: Gastrointestinal or Genitourinary prophylaxis
- Gastrointestinal or Genitourinary prophylaxis is no longer recommended (see above)
- Prior guidelines (1997)
- High risk patients were given Ampicillin and Gentamicin before and Ampicillin after procedure
- Moderate risk patients were given Ampicillin before and after procedure
- Penicillin allergic patients were given Vancomycin in place of Ampicillin
X. Reference
- (2016) Sanford Guide, accessed mobile version 3/7/2016
- Dajani (1997) JAMA 277(22):1794-1801 [PubMed]
- (2007) Circulation 116(15):1736-54 [PubMed]