If you have congenital heart disease, print out this information and give it to your physician. You can also download a PDF version of the wallet card. Healthcare Professionals: Please see below for reference to the complete statement.

Dental procedures for which endocarditis prophylaxis is recommended¹

• Dental extractions
  
• Periodontal procedures including surgery, scaling, and root planing, probing, and recall maintenance
  
• Endodontic (root canal) instrumentation or surgery only beyond the 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 where bleeding is anticipated
  

¹Prophylaxis is recommended for patients with high- and moderate-risk cardiac conditions

Other procedures for which endocarditis prophylaxis is recommended

Respiratory tract

• Tonsillectomy and/or adenoidectomy
  
• Surgical operations that involve respiratory mucosa
  
• Bronchoscopy with a rigid bronchoscope
  

Gastrointestinal tract²

• Sclerotherapy for esophageal varices
  
• Esophageal stricture dilation
  Endoscopic retrograde cholangiography with biliary obstruction
  
• Biliary tract surgery
  
• Surgical operations that involve intestinal mucosa
  

Genitourinary tract

• Prostatic surgery
  
• Cystoscopy
  
• Urethral dilation
  

²Prophylaxis is recommended for high-risk patients; it is optional for medium-risk patients.

Prophylactic Regimens for Dental, Oral, Respiratory Tract, or Esophageal Procedures. (Follow-up dose no longer recommended.) Total children’s dose should not exceed adult dose.

I. Standard general prophylaxis for patients at risk:
Amoxicillin: Adults, 2.0 g (children, 50 mg/kg) given orally one hour before procedure.

II. Unable to take oral medications:
Ampicillin: Adults, 2.0 g (children 50 mg/kg) given IM or IV within 30 minutes before procedure.

III. Amoxicillin/ampicillin/penicillin allergic patients:
Clindamycin: Adults, 600 mg (children 20 mg/kg) given orally one hour before procedure. -OR-
Cephalexin* or Cefadroxil*: Adults, 2.0 g (children 50 mg/kg) orally one hour before procedure. -OR-
Azithromycin or Clarithromycin: Adults, 500 mg (children 15 mg/kg) orally one hour before procedure.

IV. Amoxicillin/ampicillin/penicillin allergic patients unable to take oral medications:
Clindamycin: Adults, 600 mg (children 20 mg/kg) IV within 30 minutes before procedure. -OR-
Cefazolin*: Adults, 1.0 g (children 25 mg/kg) IM or IV within 30 minutes before procedure.

*Cephalosporins should not be used in patients with immediate-type hypersensitivity reaction to penicillins.

Cardiac Conditions Associated With Endocarditis:

High-risk category:

• Prosthetic cardiac valves, including bioprosthetic and
  homograft valves
  
• Previous bacterial endocarditis
  
• Complex cyanotic congenital heart disease (e.g., single ventricle states, transposition of the great arteries, tetralogy of Fallot)
  
• Surgically constructed systemic pulmonary shunts or conduits
  

Moderate-risk category

• Most other congenital cardiac malformations (other than above)
  
• Acquired valvar dysfunction (e.g., rheumatic heart disease)
  
• Hypertrophic cardiomyopathy
  
• Mitral valve prolapse with valvar regurgitation and/or thickened leaflets

I. High-risk patients:

Ampicillin plus gentamicin: Ampicillin (adults, 2.0 g; children 50 mg/kg) plus gentamicin 1.5 mg/kg (for both adults and children, not to exceed 120 mg) IM or IV within 30 minutes before starting procedure. 6 hours later, ampicillin (adults, 1.0 g; children, 25 mg/kg) IM or IV, or amoxicillin (adults, 1.0 g; children, 25 mg/kg) orally.

II. High-risk patients allergic to ampicillin/amoxicillin:

Vancomycin plus gentamicin: Vancomycin (adults, 1.0 g; children, 20 mg/kg) IV over 1–2 hours plus gentamicin 1.5 mg/kg (for both adults and children, not to exceed 120 mg) IM or IV. Complete injection/infusion within 30 minutes before starting procedure.

III. Moderate-risk patients:

Amoxicillin: Adults, 2.0 g (children 50 mg/kg) orally one hour before procedure -OR-
Ampicillin: Adults, 2.0 g (children 50 mg/kg) IM or IV within 30 minutes before starting procedure.

IV. Moderate-risk patients allergic to ampicillin/amoxicillin:

Vancomycin: Adults, 1.0 g (children 20 mg/kg) IV over 1–2 hours. Complete infusion within 30 minutes of starting the procedure.

NOTE: For patients already taking an antibiotic, or for other special situations, please refer to the full statement
referenced below.

Adapted from Prevention of Bacterial Endocarditis: Recommendations by the American Heart Association by the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease. JAMA 1997, 277:1794–1801, Circulation 1997, 96:358–366, and JADA 1997, 128:1142-1150.

Health Care Professionals — Please refer to these recommendations (endorsed by the American Dental Association and American Society for Gastrointestinal Endoscopy) for more complete information as to which patients and which procedures need prophylaxis.

The Council on Dental Therapeutics of the American Dental Association has approved this statement as it relates to dentistry.