Antibiotic Prophylaxis for Bacterial Endocarditis

Subject:   Antibiotic Prophylaxis for Bacterial Endocarditis
Effective Date:   November 2002
Revision Dates:    May 2007, October 2016

Purpose

To protect patients who are at risk for the development of infectious endocarditis (IE) subsequent to dentally-induced bacteremias.

General Policy

The University of Washington School of Dentistry adopts the current recommendations of the American Heart Association (AHA) and the American Dental Association (ADA) for the prevention of infectious endocarditis.  This policy will automatically adopt the current guidelines of these organizations when they are published.

Implementation

I. Patients who are at risk for infectious endocarditis shall be treated using the current AHA and ADA guidelines for the prevention of bacterial endocarditis unless a significant medical reason documented by the patient’s physician exists for deviating from this policy.

Previously patients with nearly every type of congenital heart defect needed to receive prophylactic antibiotics prior to dental procedures, but the AHA simplified it’s recommendations in 2007, and updated in 2015, and 2016.  The practice of giving patients antibiotics prior to a dental procedure is not recommended EXCEPT for patients with the highest risk of adverse outcomes resulting from IE.

See: Antibiotic Prophylaxis Prior to Dental Procedures

II. Primary regimes for dental procedures are as follows:

TABLE 1. Regimens for a Dental Procedure (1)

Regimen: Single Dose 30 to 60 min Before Procedure

Regimens for a Dental Procedure

Situation	Agent	Adults	Children
Oral	Amoxicillin	2 g	50 mg/kg
Unable to take oral medication	Ampicillin	2 g IM or IV	50 mg/kg IM or IV
	OR Cefazolin or ceftriaxone	1 g IM or IV	50 mg/kg IM or IV
Allergic to penicillins or ampicillin—oral	Cephalexin*†	2 g	50 mg/kg
	OR Clindamycin	600 mg	20 mg/kg
	OR Azithromycin or clarithromycin	500 mg	15 mg/kg
Allergic to penicillins or ampicillin and unable to take  oral medication	Cefazolin or ceftriaxone†	1 g IM or IV	50 mg/kg IM or IV
	OR Clindamycin	600 mg IM or IV	20 mg/kg IM or IV

IM indicates intramuscular; IV, intravenous.

*Or other first- or second-generation oral cephalosporin in equivalent adult or pediatric dosage.

†Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema, or urticaria with penicillins or ampicillin.

Reference: Antibiotic Prophylactic Regimens for Dental Procedures © 2016, American Heart Association. All Rights Reserved. 50-1605 1606 The Council on Scientific Affairs of the American Dental Association has approved this statement as it relates to dentistry. National Center 7272 Greenville Avenue Dallas, Texas 75231-4596 www.heart.org

Dean of UW SOD:

Joel Berg, Dean of the UW School of Dentistry

October 24, 2016