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Chapter 8. Infective Endocarditis Prophylaxis

Edward C. Lin, MD

In 2007, the AHA published revised guidelines for the prevention of infective endocarditis.

Table 8-1 Conditions Where It Is Reasonable to Give Antibiotics to Prevent Infective Endocarditis (IE)
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Table 8-1 Conditions Where It Is Reasonable to Give Antibiotics to Prevent Infective Endocarditis (IE)
  • Prosthetic cardiac valve or prosthetic material used for cardiac valve repair
  • History of IE
  • Unrepaired cyanotic CHD (including palliative shunts and conduits)
  • For the first 6 months after completely repairing a congenital heart defect with prosthetic material or device
  • Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device
  • Valvulopathy after cardiac transplantation
Table 8-2 Procedures for Which It Is Reasonable to Give Antibiotics to Patients with the Conditions Given in Table 8-1
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Table 8-2 Procedures for Which It Is Reasonable to Give Antibiotics to Patients with the Conditions Given in Table 8-1
LocationCaveats
Dental
  • Give only for procedures involving manipulation of the gingival tissue or the periapical region of teeth or perforation of the oral mucosa
Respiratory tract
  • For procedures involving incision or biopsy of mucosa
  • If procedure is to treat infection, use antibiotic that covers Streptococcus viridans, or, if infection known/suspected to be secondary to S. aureus, give antibiotic that covers S. aureus (use vancomycin if MRSA)
Infected skin/skin structure/MSK
  • Ensure that the antibiotic given will cover staphylococci and beta-hemolytic Streptococcus
GI or GU tract procedures
  • Antibiotics not recommended if only given to prevent infective endocarditis
  • Coverage for enterococci reasonable if:

    1. Patient has an established GI or GU infection

    2. Patient on antibiotics to prevent sepsis/wound infection from a GI or GU procedure

    3. Cystoscopy or urinary tract manipulation in a patient with an existing urinary tract enterococcal infection or colonization

    4. Urinary tract procedure is not elective

Table 8-3 Antibiotic Regimen for Dental Procedures
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Table 8-3 Antibiotic Regimen for Dental Procedures
AntibioticAdult dosePediatric dose (mg/kg)
OralAmoxicillin2 g50
Oral + allergic to PCN
  • Cephalexin
  • Clindamycin
  • Azithromycin/clarithromycin
  • 2 g
  • 600 mg
  • 500 mg
  • 50
  • 20
  • 15
Intravenous/intramuscular
  • Ampicillin
  • Cefazolin/ceftriaxone
  • 2 g
  • 1 g
  • 50
  • 50
Intravenous/intramuscular + allergic to PCN
  • Cefazolin/ceftriaxone
  • Clindamycin
  • 1 g
  • 600 mg
  • 50
  • 20
+
+
1. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. J Am Dent Assoc. 2008 Jan;139 Suppl:3S–24S.   [PubMed: 18167394]

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