07. Prophylaxis for Bacterial Endocarditis

AHA/ACC guidelines (2007) recommend pre-procedural antibiotics to prevent infectious endocarditis (IE) for a narrow list of valvular disease (those at highest risk of adverse outcome for IE) AND certain procedures.

Patient Population

  • Prior episode of IE
  • Prosthetic valvular intervention
    • Valve replacement (mechanical, bioprosthetic, and homograft valves)
    • Valve repair (annuloplasty rings, chords)
  • Congenital heart disease
    • Unrepaired cyanotic congenital heart disease (tricuspid atresia, transposition of the great arteries, tetralogy of fallot, truncus arteriosus)
    • Completely repaired congenital heart defect with prosthetic material or device during the first 6 months after procedure (prior to endothelialization)
    • Repaired congenital heart defect with residual defects at or adjacent to site of a prosthetic patch/device (cannot endothelialize)
  • Cardiac transplant recipients with valvular regurgitation

Procedures

  • Dental procedures in which there may be manipulation of gingival tissue or periapical region of teeth, or perforation of the oral mucosa
    • Not indicated for routine anesthetic injections, dental radiographs, placement of removable prosthodontics or orthodontic appliances, adjustment of orthodontic appliances, placement of orthodontic brackets, shedding of deciduous teeth, and bleeding from trauma to the lips or oral mucosa
  • Invasive procedure of the respiratory tract: incision or biopsy of respiratory mucosa (e.g. tonsillectomy, adenoidectomy)
    • Not indicated for routine bronchoscopy
  • Surgical procedure for management of infected skin

Regimen

Route

Regimen

PO

Amoxicillin 2G OR

Cephalexin 2G OR 

Clindamycin 600mg OR

Azithromycin/Clarithromycin 500mg 

IM/IV

Ampicillin 2G OR 

Clindamycin 600mg OR 

Ceftriaxone/Cefazolin 1G

Administer one dose 30-60 minutes prior to procedure

 

Nishimura RA et al. ACC/AHA 2014 Guideline for the Management of Patients with Valvular Heart Disease. Circulation 2014; e57-185.

Wilson Walter, Taubert Kathryn A., Gewitz Michael, et al. Prevention of Infective Endocarditis. Circulation 2007;116(15):1736–54.

Nishimura RA et al. ACC/AHA 2008 Guideline Update on Valvular Heart Disease: Focused Update on Infective Endocarditis. Circulation 2008; 887-896.