100 Colony Square, Suite 1202
1175 Peachtree Street NE
Atlanta, Georgia 30361
Office: (404) 874-1115 Fax: (404) 874-0624
Metropolitan Oral & Maxillofacial Surgery Associates
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Joyce T. Lee, M.D., D.D.S.
New guidelines published 04/07/2007 from the American Heart Association..
Antibiotic prophylaxis with dental procedures is recommended only for patients with cardiac conditions associated with the highest risk of adverse outcomes from
endocarditis, including:
Prosthetic cardiac valve
Previous endocarditis
Congenital heart disease only in the following categories:
–Unrepaired cyanotic congenital heart disease, including those with palliative shunts and conduits
–Completely repaired congenital heart disease with prosthetic material or device, whether placed by surgery or catheter intervention, during the first six months after the procedure*
–Repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
Cardiac transplantation recipients with cardiac valvular disease
*Prophylaxis is recommended because endothelialization of prosthetic material occurs within six months after the procedure.
Dental procedures for which prophylaxis is recommended in patients with cardiac conditions listed above:
All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth, or perforation of the oral mucosa*
*Antibiotic prophylaxis is NOT recommended for the following dental procedures or events: routine anesthetic injections through noninfected tissue; taking dental
radiographs; placement of removable prosthodontic or orthodontic appliances; adjustment of orthodontic appliances; placement of orthodontic brackets; and shedding of
deciduous teeth and bleeding from trauma to the lips or oral mucosa.
Antibiotic Prophylactic Regimens Recommended for Dental Procedures
Situation
Agent
Regimen – Single dose 30–60 minutes before procedure
Adults
Children
Oral
Amoxicillin
2 gm
50 mg/kg
Unable to take oral medication
Ampicillin
OR
2 g IM or IV*
50 mg/kg IM or IV
Cefazolin or ceftriaxone
1 g IM or IV
50 mg/kg IM or IV
Allergic to penicillins or ampicillin –
Oral regimen
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†
OR
1 g IM or IV
50 mg/kg IM or IV
Clindamycin
600 mg IM or IV
20 mg/kg IM or IV
*IM – 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.
Antibiotic prophylaxis with dental procedures is recommended only for patients with cardiac conditions associated with the highest risk of adverse outcomes from
endocarditis, including:
Prosthetic cardiac valve
Previous endocarditis
Congenital heart disease only in the following categories:
–Unrepaired cyanotic congenital heart disease, including those with palliative shunts and conduits
–Completely repaired congenital heart disease with prosthetic material or device, whether placed by surgery or catheter intervention, during the first six months after the procedure*
–Repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
Cardiac transplantation recipients with cardiac valvular disease
*Prophylaxis is recommended because endothelialization of prosthetic material occurs within six months after the procedure.
Dental procedures for which prophylaxis is recommended in patients with cardiac conditions listed above:
All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth, or perforation of the oral mucosa*
*Antibiotic prophylaxis is NOT recommended for the following dental procedures or events: routine anesthetic injections through noninfected tissue; taking dental
radiographs; placement of removable prosthodontic or orthodontic appliances; adjustment of orthodontic appliances; placement of orthodontic brackets; and shedding of
deciduous teeth and bleeding from trauma to the lips or oral mucosa.
Antibiotic Prophylactic Regimens Recommended for Dental Procedures
Situation
Agent
Regimen – Single dose 30–60 minutes before procedure
Adults
Children
Oral
Amoxicillin
2 gm
50 mg/kg
Unable to take oral medication
Ampicillin
OR
2 g IM or IV*
50 mg/kg IM or IV
Cefazolin or ceftriaxone
1 g IM or IV
50 mg/kg IM or IV
Allergic to penicillins or ampicillin –
Oral regimen
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†
OR
1 g IM or IV
50 mg/kg IM or IV
Clindamycin
600 mg IM or IV
20 mg/kg IM or IV
*IM – 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.
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