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CARDIAC CONDITIONS CONSIDERED FOR PROPHYLAXIS.

HIGH-RISK MODERATE RISK NEGLIGIBLE RISK:


CATEGORY NO ANTIBIOTIC
PROPHYLAXIS
RECOMMENDED
Prosthetic cardiac Most other congenital Isolated secundum atrial
valves cardiac malformations not septal
otherwise indicated defect
Previous bacterial
endocarditis Acquired valvular Surgical repair of atrial
dysfunction septal
Complex, cyanotic defect, ventricular septal
congenital heart Hypertrophic defect or
disease cardiomyopathy patent ductus arteriosus of
more
Surgically Mitral valve prolapse with than six months’ duration
constructed systemic regurgitation and/or
pulmonary shunts thickened valve leaflets Previous coronary artery
bypass graft surgery

Physiological or
functional
heart murmur

Previous Kawasaki
disease
without valvular
dysfunction

Previous rheumatic fever


without valvular
dysfunction

Cardiac pacemakers

Implanted defibrillators

* Adapted with permission of the Journal of the American Medical Association from Dajani and
colleagues.10
ANTIBIOTIC PROPHYLACTIC REGIMENS FOR CERTAIN DENTAL
PROCEDURES.*
(TABLE 1)
SITUATION ANTIBIOTIC† REGIMEN‡
Standard Amoxicillin Adults, 2.0 grams; children,
Prophylaxis 50 milligrams/kilogram
orally one hour before
procedure

Cannot Use Oral Ampicillin Adults, 2.0 g IM§ or IV§;


Medications children, 50 mg/kg IM or
IV within 30 minutes
before procedure

Allergic to Penicillin Clindamycin Adults, 600 mg; children,


20 mg/kg orally one hour
before procedure

Cephalexin or cefadroxil Adults, 2.0 g; children,


50 mg/kg orally one hour
before procedure

Azithromycin or Adults, 500 mg; children,


clarithromycin 15 mg/kg orally one hour
before procedure

Allergic to Clindamycin Adults, 600 mg; children,


Penicillin and Unable 15 mg/kg IV one hour
to Take Oral before procedure
Medications
Cefazolin Adults, 1.0 g; children,
25 mg/kg IM or IV within
30 minutes before procedure

* Reprinted with permission of the Journal of the American Medical Association from Dajani
and colleagues.10
† Cephalosporins should not be used in patients with immediate-type hypersensitivity reaction
(urticaria, angioedema or anaphylaxis) to
penicillins.
‡ Total children’s dose should not exceed adult dose.
§ IM: Intramuscular; IV: Intravenous.
DENTAL PROCEDURES CONSIDERED FOR ANTIBIOTIC
PROPHYLAXIS IN SUSCEPTIBLE PATIENTS.*

HIGH-RISK CATEGORY

Dental extractions

Periodontal procedures including surgery, scaling, root


planing and probing

Dental implant placement, reimplantation of teeth

Endodontic instrumentation or surgery beyond the


tooth apex

Subgingival placement of antibiotic fibers or strips

Initial placement of orthodontic bands but not brackets

Intraligamentary local anesthetic injections

Prophylactic cleaning of teeth or implants with


anticipated bleeding

PROCEDURES NOT RECOMMENDED FOR PROPHYLAXIS

Restorative dental procedures with or without


retraction cord

Local anesthetic injections (except for intraligamentary)

Intracanal endodontic procedures, post placement and


buildup

Placement of rubber dams

Postoperative suture removal

Placement of removable orthodontic or prosthodontic


appliances

Taking oral impressions

Fluoride treatments

Taking oral radiographs

Orthodontic appliance adjustment


Shedding of primary teeth

* Adapted with permission of the Journal of the American Medical Association from Dajani
and colleagues.10
SUMMARY RECOMMENDATIONS FOR ANTIBIOTIC PROPHYLAXIS.

MEDICAL CONDITION PROPHYLAXIS ANTIBIOTIC REGIMEN


RECOMMENDED?

Valvular Heart Disease, YES AHA protocol*†


Previous Endocarditis,
Surgical Pulmonary
Shunts, Hypertrophic
Cardiomyopathy

Mitral Valve Prolapse YES AHA protocol*†


With Regurgitation

Prosthetic Heart Valves YES AHA protocol*†

Orthopedic Prostheses NO, except in exceptional cases


More Than Two Years in of immune compromise
Place

Implanted Pacemaker or NO
Defibrillator

Vascular Grafts NO, if in place more than 6 AHA protocol if less than
months six months

Previous Coronary NO
Bypass Graft Surgery

Renal Hemodialysis YES, although definite evidence AHA protocol*†


With AV* Shunts is lacking

VA* Shunts for Hydrocephalus YES AHA protocol*†

VP* Shunts for Hydrocephalus NO

Patients With NO for most dental procedures; No specific antibiotic


Compromised Immune may consider for invasive regimen recommended
Systems procedures or specific
situations

Prevention of Local NO, although treatment of No specific antibiotic


Infection in Surgical coexistent infection is regimen recommended
Sites recommended before surgical
procedures
* AHA: American Heart Association; AV: Arteriovenous; VA: Ventriculoatrial; VP:
Ventriculoperitoneal.
† See Table 1 for protocol.

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