Endocarditis Prophylaxis
Dental Procedures
Prophylaxis against Infective Endocarditis (IE) should only be considered in patients at the highest risk of IE undergoing an at-risk procedure.
Patients at highest risk:
- Previous episode of IE
- Surgically implanted prosthetic valves and with any material used for cardiac valve repair
- Transcatheter implanted aortic and pulmonary prostheses
- Untreated cyanotic congenital heart disease (CHD)
- CHD treated with surgery or transcatheter procedures with post-operative palliative shunts, conduits, or other prostheses
- Only for 6 months after procedure unless residual defects or valve prostheses
- Ventricular assist devices
- In patients with transcatheter mitral and tricuspid valve repair.
- May be considered in heart transplant recipients.
At-risk dental or oral surgery procedures:
- Dental extractions
- Oral surgery procedures (periodontal surgery, oral surgery and oral biopsies)
- Manipulation of the gingival or periapical region of the teeth (including scaling and root canal procedures)
Preferred
amoxicillin 2g po given 30-60 mins before procedure
Alternative
For penicillin allergy (non-severe):
cefalexin 2g po given 30-60mins before procedure
For penicillin allergy (severe):
doxycycline 200mg po or clarithromycin 500mg po given 30-60mins before procedure
Non-dental procedures
Systemic antibiotic prophylaxis may be recommended for non-dental procedures. Antibiotic therapy is only indicated in patients at the highest risk when invasive procedures are performed in the context of infection (e.g. drainage of an abscess). Discuss with Micro/ID if unsure.