Prevention of Bacterial Endocarditis

Choice of Antibiotics

Indication for Therapy	Usual Causative Organisms	Antimicrobial Regimens
Patients with high risk cardiac conditions^* undergoing the following interventions: Dental procedures involving manipulation of gingival tissue/periapical region of teeth or perforation of the oral mucosa Respiratory tract procedures involving excision of the mucosa (i.e. tonsillectomy, andenoidectomy and bronchoscopy with biopsy) Procedures involving infected skin, skin structure or musculoskeletal tissue	Viridans group streptococci, other Streptococcus spp., Staphylococcus spp.	Standard General Prophylaxis^†
		amoxicillin 2 g PO x 1 dose 1 hour prior to procedure
		β-lactam allergy (non-anaphylaxis): cephalexin 2 g PO x 1 dose 1 hour prior to procedure
		β-lactam allergy (anaphylaxis): clindamycin 600 mg PO x 1 dose 1 hour prior to procedure OR clarithromycin 500 mg PO x 1 dose 1 hour prior to procedure
		Unable to take Oral Medications
		ampicillin 2 g IV/IM x 1 dose within 30 min before procedure
		β-lactam allergy (non-anaphylaxis): ceFAZolin 1 g IV x 1 dose 1 hour prior to procedure
		β-lactam allergy (anaphylaxis): vancomycin 15 mg/kg IV once (not to exceed 2 grams) within 120 minutes prior to procedure
Gastrointestinal and genitourinary procedures	Enterococcus spp.	Routine prophylaxis no longer recommended^‡

^* Cardiac conditions associated with highest risk of adverse outcomes from endocarditis:

Prosthetic cardiac valve
Previous infective endocarditis
Congenital heart disease (CHD) with non-repaired cyanotic CHD (including palliative shunts & conduits) or completely repaired congenital heart defect with prosthetic material or device during first 6 months after procedure or repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or device
Cardiac transplant recipients who develop cardiac valvulopathy (i.e. documented substantial leaflet pathology and regurgitation)

^† In the event that an antibiotic is inadvertently not given prior to the procedure the dosage may be given up to 2 hours afterwards.

^‡ Patients with an established GI/GU infection or enterococcal colonization should receive prophylaxis with amoxicillin/ampicillin or vancomycin (if patient has a penicillin allergy).

References:

Prevention of Infective Endocarditis – Guidelines from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee. Circulation. 2007; 116:1736-1754.