Hygiene Atlas

Atlas · Plate VIII · Pharmacology and Local Anesthesia · 05

Antibiotic premedication

Under AHA 2021, endocarditis prophylaxis is reserved for the highest-risk cardiac patients, such as those with a prosthetic valve, previous endocarditis, certain congenital heart disease or a heart transplant with valve disease, before procedures that manipulate gingiva or perforate mucosa. The adult dose is amoxicillin 2 g taken 30-60 minutes before. Clindamycin is no longer recommended, and prosthetic joints generally do not need prophylaxis.

High-yield facts · 9

  1. AHA 2021: IE prophylaxis only for highest-risk cardiac patients undergoing procedures that manipulate gingiva, the periapical region or perforate mucosa.S5S4
  2. Highest risk: prosthetic valves (including transcatheter and homografts), prosthetic valve-repair material, previous IE, certain congenital heart disease, cardiac transplant with valvulopathy.S5S4
  3. Congenital conditions: unrepaired cyanotic CHD (including palliative shunts/conduits); repair with prosthetic material in the first 6 months; repaired defects with residual shunts/leaks at or near prosthetic material.S5S4
  4. Not indicated for: mitral valve prolapse, rheumatic heart disease without a valve prosthesis, stents, pacemakers, bicuspid aortic valve, prior CABG.S5
  5. Oral regimen, 30-60 min before: amoxicillin 2 g adult, 50 mg/kg child.S5
  6. Penicillin allergy: cephalexin 2 g (child 50 mg/kg) if no anaphylaxis/angioedema/urticaria history with penicillin; azithromycin or clarithromycin 500 mg (child 15 mg/kg); doxycycline 100 mg (child under 45 kg: 2.2 mg/kg).S5
  7. Unable to take oral: ampicillin 2 g IM/IV (child 50 mg/kg) or cefazolin/ceftriaxone 1 g IM/IV (child 50 mg/kg).S5
  8. If the dose was missed, it can be given up to 2 hours after the procedure.S5S4
  9. Prosthetic joints: ADA 2015 says prophylaxis is generally not recommended; decisions are shared with the orthopedic surgeon.S4

Facts are written in our own words; each tag links to its source. Values marked "sources vary" differ between references, so check the one your program uses.